Alcoholic encephalopathy – defeat of cells of a brain as a result of alcohol intake. Usually develops at the end of II – the beginning of the III stage of alcoholism though also earlier beginning is possible. Can proceed sharply or chronically. Is followed by mental, somatic and neurologic violations. Deterioration in appetite, decrease in body weight, deterioration in coordination of movements, constant fatigue, uneasiness, instability of mood and violation of memory is characteristic. Crazy and hallucinatory frustration are possible. Treatment is conservative.
Alcoholic encephalopathy – the disease which is followed by destruction of cells of a brain under the influence of alcohol. The disease, as a rule, arises shortly before transition or after transition of the II stage of alcoholism to III. Duration of constant alcohol intake before emergence of the first symptoms fluctuates from 7 to 20 years, however also earlier onset of the illness is possible. In some cases symptoms can arise in the absence of alcoholism against the background of periodic alcohol intake.
Alcoholic encephalopathy is a serious disease and demands the early qualified treatment. The quantity of lethal outcomes at this pathology according to various experts in the field of narcology makes 30-70%. In other cases mental disorders of various degree of expressiveness become an outcome, as a rule. Development of a psychoorganic syndrome, pseudo-paralytic syndrome or weak-mindedness is possible. Treatment of alcoholic encephalopathy long, is performed in the conditions of a narcological hospital.
Reasons of development of alcoholic encephalopathies
The long use of high doses of alcohol becomes the reason of development of this disease in most cases. As a rule, emergence of the first symptoms is preceded by hard drinkings proceeding within weeks or months or habitual daily reception of alcohol for many years. The risk of developing of a disease increases at the use of technical liquids and substitutes of alcohol. Sometimes because of specific features of an organism of the patient the disease develops in the absence of alcoholism, against the background of the regular use of small doses of alcohol or rare alcoholic excesses.
Diseases are the cornerstone of a metabolic disorder, characteristic of alcoholism. The leading role is played by a lack of vitamins (first of all – groups B). At constant alcohol intake the need of an organism for B1 vitamin increases, and its level decreases. It is caused by irregular monotonous food, lack of appetite during hard drinkings, deterioration in absorption of B1 vitamin in intestines and dysfunction of a liver. Exchange frustration in a brain turn out to be consequence of deficiency of B1. The problem is aggravated with a lack of P and V6 vitamin. Because of deficiency of these vitamins functions of a gastrointestinal tract are even more broken, and capillaries in a brain become more permeable that can lead to brain hypostasis.
Depending on the speed of development, the prevailing symptoms, features of a current and options of an outcome distinguish two groups of alcoholic encephalopathies: sharp and chronic. Carry hemorrhagic polyencephalitis (Gayet-Vernique's syndrome), mitigirovanny sharp encephalopathy and encephalopathy with a lightning current to number of sharp encephalopathies. In the anamnesis at the patients having chronic encephalopathies, as a rule, heavy alcoholic psychoses or sharp encephalopathies come to light. There are two forms of chronic alcoholic encephalopathy: korsakovsky psychosis (alcoholic paralysis, polinevritichesky psychosis) and alcoholic pseudo-paralysis.
Sharp alcoholic encephalopathies
In the beginning there are disease symptoms harbingers. There is an adynamy in combination with frustration of a dream and appetite. Patients revolt to the products rich with fats and proteins, and prefer food with the high content of carbohydrates that promotes aggravation of already arisen exchange violations. Sometimes anorexia develops. Violations from digestive tract come to light. Quite often (especially in the mornings) there is nausea and vomiting. Belly-aches, an eructation, heartburn and violations of a chair are possible. The physical condition of patients quickly worsens, weight is lost, exhaustion accrues. Signs of an alcoholic polyneuropathy can come to light.
Gayet-Vernique's encephalopathy in classical option begins with a deliriya of moderate severity. Patients have monotonous fragmentary visual illusions and hallucinations in a combination to the difficult repeating movements. The periods of excitement are replaced by short episodes of an immovability, the muscular tone during such episodes remains raised. Patients mutter something or cry out, productive communication becomes impossible.
Puffiness of the person in combination with the general exhaustion is observed. There is an ataxy, multiple neurologic frustration come to light (, the different size of pupils, unsharply expressed paresis etc.). Body temperature is increased, pulse and breath are speeded up, the tendency to decrease HELL is noted at deterioration in the general state. From system of digestion change of color of language (crimson) and increase in a liver is found. Violations of a chair are possible. In process of aggravation of clinical symptomatology there are progressing consciousness violations – from easy devocalization to a stupor. In hard cases the coma develops.
Death can come in 10-15 days from the moment of emergence of the first symptoms a deliriya. The probability of a lethal outcome increases at accession of interkurrentny diseases – pneumonia, decubituses etc. At favorable succession of events of deliriya proceeds from 3 weeks to 1,5 months. The psychoorganic syndrome which is expressed in mental helplessness, a memory impairment and loss of ability to adapt to usual everyday life becomes an outcome of a disease. At patients the strong-willed sphere suffers, working capacity and level of resistance to stresses decreases. Transition of sharp alcoholic encephalopathy to chronic is possible.
Mitigirovanny sharp encephalopathy begins with harbingers in the form of an adynamy, deterioration in mood, loss of appetite and frustration of a dream. The expressed concern and tendency to morbid depression is observed. Neurologic violations are presented by softly expressed neuritis. The Prodromalny period lasts 1-2 months, then develops deliriya. After an exit from psychosis the residual phenomena in the form of an adynamy and the long, badly giving in to medical correction disorders of memory are observed.
The supersharp form of alcoholic encephalopathy is characterized by bystry development and an adverse current with frequent lethal outcomes. Duration of the period of harbingers makes about 3 weeks. Then there is heavy psychosis which is followed by the expressed neurologic and somatic violations. Body temperature increases to 40-41 degrees, the progressing consciousness violations are observed. Within several days there comes the coma, and then death. At the survived patients after the termination the deliriya develops a pseudo-paralytic syndrome – carelessness, feeling of full satisfaction with and people around in combination with lack of criticism, revaluation of the opportunities and ridiculous behavior.
Chronic alcoholic encephalopathies
Korsakovsky psychosis is more often observed at women, shown by memory violations, false memoirs and disorientation. Patients badly remember new information, hardly remember what happened to them prior to the beginning of a disease. In a conversation with patients it becomes clear that they often "remember" events which were not actually. Orientation in space, the place and time is complicated. Poverty of the speech and motive reactions is noted. Neurologic frustration in the form of neuritis come to light. At alcohol cancellation symptoms of a disease can be reduced.
Alcoholic pseudo-paralysis usually arises at men. Perhaps both gradual development, and bystry progressing of symptoms after sharp alcoholic psychosis. Dementia with loss of former knowledge and skills, disorders of memory and decrease in criticism to the state is characteristic. The posterization (roughness, cynicism) in combination with sharp differences of mood is observed. The neurologic symptomatology is presented by polyneuritis, violations of the speech, trembling of muscles of hands and persons.
Diagnostics and treatment of alcoholic encephalopathy
The diagnosis is exposed on the basis of the anamnesis and clinical symptoms, the differential diagnosis is carried out with other forms of psychoses, schizophrenia, malignant and good-quality new growths of a brain. Treatment provides selection of the balanced menu with the high content of proteins and vitamins. To patients appoint high doses of thiamine, a nootropa, medicines for improvement of brain blood circulation and activization of a metabolism in a brain. Carry out treatment of the accompanying somatic pathology.
The major role in successful treatment of alcoholic encephalopathies, minimization of the residual phenomena and the prevention of transition of a sharp form of a disease to chronic encephalopathy is played by full refusal of alcohol. The choice of tactics and methods of treatment of alcoholic dependence is defined by the narcologist individually, depending on a concrete case. Perhaps vshivany an implant, use of medicamentous ways of treatment, gipnosuggestivny therapy or coding across Dovzhenko. Carrying out complex rehabilitation with the subsequent observation of the expert, visit of the psychotherapist or support groups is desirable.