Encephalopathy

Encephalopathy is the term for symptoms that happen when your brain is not working properly.

The symptoms of encephalopathy vary between people.

The most common symptom of encephalopathy is a change in mental state, with problems such as:

• loss of memory
• difficulty concentrating
• drowsiness
• changes in personality
• confusion

Some people might have:

• jerky eye movements
• poor balance
• difficulty coordinating muscle movements
• muscle twitching or tremors
• seizures
• dementia

Some people may also become unconscious.

Encephalopathy can be caused by many conditions, for example:

• infections
• some medicines
• diabetic ketoacidosis
• kidney failure
• cancer
• autoimmune conditions
• poisoning

Regardless of the cause, sedative medicines, such as sleeping tablets, can make the symptoms worse.

Types of encephalopathy

There are many types of encephalopathy — here are some examples:

• Hepatic encephalopathy occurs when the liver doesn't work properly and can't remove toxic (poisonous) substances from the blood. This causes ammonia to build up, which affects brain function.
• Chronic traumatic encephalopathy (CTE) is caused by repeated head knocks or concussions. It is often linked with contact sports, such as boxing and football, but can also result from non-sporting injuries.
• Hypoxic-ischaemic encephalopathy happens when a baby's brain does not get enough oxygen around the time of birth, leading to abnormal brain function.
• Wernicke encephalopathy results from a severe deficiency of thiamine (vitamin B1) and can lead to permanent brain damage. It happens more often in people with severe alcohol addiction.

Because encephalopathy is a broad term with many causes, it's important to speak to your doctor about what it means in your situation.

If you notice any new problems that might be symptoms of encephalopathy, see your doctor. This is especially important if you have an underlying problem, such as liver disease, because encephalopathy can become an emergency.

When should I seek urgent care?

Encephalopathy is diagnosed based on your symptoms.

To work out if you have encephalopathy, and what might be causing it, your doctor might:

• ask about your symptoms
• talk to your friends or family about any recent behaviour changes
• examine you
• refer you for blood tests
• recommend a lumbar puncture to check the fluid around your brain
• refer you for imaging, such as a CT or MRI scan

People with sudden encephalopathy usually need hospital treatment, which may include:

• addressing the causes — for example, thiamine supplements are helpful for people with Wernicke encephalopathy
• treating the symptoms — for example, anticonvulsants may help manage seizures

Encephalopathy sometimes needs ongoing treatment, more commonly for people with existing health problems. People with conditions such as liver disease are also more likely to have repeated episodes of encephalopathy.

If not treated early or properly, encephalopathy can lead to serious complications, including:

• permanent brain damage
• chronic memory problems or personality changes
• increased risk of falls or injuries
• long-term disability or loss of independence
• persistent seizures or epilepsy
• coma or death, especially in severe or untreated cases

Some types of encephalopathy can get worse over time and cause permanent damage that can't be reversed. These include chronic traumatic encephalopathy and Wernicke encephalopathy.

Sometimes, you can prevent encephalopathy, especially if you treat what's causing it early. Ways to help prevent encephalopathy include:

• taking care of long term health conditions like liver or kidney disease, diabetes and high blood pressure (hypertension)
• not drinking too much alcohol
• eat healthy food and make sure you get enough vitamin B1 (thiamine)
• wearing protective gear in contact sports to reduce the risk of head injury
• staying away from harmful chemicals or poisons
• taking medications as your doctor tells you and avoiding sedatives unless recommended by your doctor

Finding and treating health problems that might cause encephalopathy early is important to help stop it from happening.

The Liver Foundation has information about hepatic encephalopathy (Opens in new tab).

For information about chronic traumatic encephalopathy visit:

• Dementia Australia (Opens in new tab)
• Brain Foundation (Opens in new tab)

The Queensland Government has information on hypoxic ischaemic encephalopathy (Opens in new tab).

Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.

The Gastroenterological Society of Australia has a factsheet on advanced liver disease (Opens in new tab) (a common cause of encephalopathy) translated into several community languages.