ABSTRACT
JUSTIFICATIVA E OBJETIVOS: As encefalopatias compõem um grupo heterogêneo de etiologias, onde a pronta e correta atuação médica direcionada à causa da doença, pode modificar o prognóstico do paciente. O objetivo deste estudo foi rever os aspectos fisiopatológicos das diferentes encefalopatias bem como seus principais fatores desencadeantes e manuseio clínico.CONTEÚDO: Foram selecionadas as mais frequentes encefalopatias observadas na prática clínica e discutir sua fisiopatologia, bem como sua abordagem terapêutica, destacando: encefalopatia hipertensiva, hipóxico-isquêmica, metabólica, Wernicke-Korsakoff, traumática e tóxica.CONCLUSÃO: Trata-se de uma complexa condição clínica que exige rápida identificação e preciso manuseio clínico com o intuito de reduzir sua elevada taxa de morbimortalidade. O atraso no reconhecimento dessa condição clínica poderá ser extremamente prejudicial ao paciente que estará sofrendo lesão cerebral muitas vezes irreversível.
BACKGROUND AND OBJECTIVES: Encephalopathies comprise a heterogeneous group of clinical conditions, in which the prompt and adequate medical intervention can modify patient prognosis. This paper aims to discuss the pathophysiological aspects of different encephalopathies, their etiology, and clinical management.CONTENTS: We selected the main encephalopathies observed in clinical practice, such as hypertensive, hypoxic-ischemic, metabolic, Wernicke-Korsakoff, traumatic, and toxic encephalopathies, and to discuss their therapeutic approaches.CONCLUSION: This is a complex clinical condition that requires rapid identification and accurate clinical management with the aim of reducing its high morbidity and mortality rates. Delay in recognizing this condition can be extremely harmful to the patient who is suffering from often irreversible brain injury.
Subject(s)
Brain Diseases/diagnosis , Brain Diseases/etiology , Brain Diseases/physiopathology , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/etiology , Hepatic Encephalopathy/physiopathology , Hypertensive Encephalopathy/diagnosis , Hypertensive Encephalopathy/etiology , Hypertensive Encephalopathy/physiopathology , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/etiology , Wernicke Encephalopathy/physiopathology , Brain Diseases, Metabolic/diagnosis , Brain Diseases, Metabolic/etiology , Brain Diseases, Metabolic/physiopathology , Hypoxia-Ischemia, Brain/diagnosis , Hypoxia-Ischemia, Brain/etiology , Hypoxia-Ischemia, Brain/physiopathology , Brain Injury, Chronic/diagnosis , Brain Injury, Chronic/etiology , Brain Injury, Chronic/physiopathologyABSTRACT
La cirugía bariátrica es un tratamiento que garantiza una pérdida de peso sustancial y duradera, y beneficios tangibles respecto a condiciones médicas asociadas a la obesidad. El aumento del número de cirugías bariátricas ha llevado también a un aumento de las complicaciones relacionadas con ella, incluyendo la encefalopatía de Wernicke y la polineuropatía por deficiencia de vitaminas del complejo B. En este artículo se reporta un caso de encefalopatía de Wernicke siete semanas después de la cirugía, enfatizando en la importancia de reconocer el espectro de la sintomatología para hacer un diagnóstico temprano, que permita intervenir en la fase reversible de esta enfermedad potencialmente letal.
Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.
Subject(s)
Adult , Female , Humans , Gastric Bypass , Polyneuropathies/etiology , Postoperative Complications/etiology , Vitamin B Deficiency/etiology , Wernicke Encephalopathy/etiology , Anxiety Disorders/diagnosis , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/etiology , Coma/diagnosis , Coma/etiology , Diagnostic Errors , Factitious Disorders/diagnosis , Hypothyroidism/complications , Mental Disorders/complications , Obesity, Morbid/complications , Obesity, Morbid/surgery , Prognosis , Polyneuropathies/diagnosis , Postoperative Complications/diagnosis , Postoperative Nausea and Vomiting/complications , Risk Factors , Urinary Tract Infections/complications , Vitamin B Complex/pharmacokinetics , Vitamin B Deficiency/diagnosis , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/drug therapy , Wernicke Encephalopathy/physiopathologySubject(s)
Humans , Male , Female , Pregnancy , Wernicke Encephalopathy/physiopathology , Dementia/etiology , Alcohol Withdrawal Delirium , Alcoholism/complications , Pellagra/etiology , Pellagra/drug therapy , Seizures/etiology , Seizures/physiopathology , Wernicke Encephalopathy/etiology , Wernicke Encephalopathy/history , Dementia/diagnosis , Dementia/physiopathology , Alcoholism/diagnosis , Alcoholism/physiopathology , Neuritis/etiology , Fetal Alcohol Spectrum Disorders/diagnosis , Fetal Alcohol Spectrum Disorders/epidemiologyABSTRACT
O alcoolismo é um dos mais graves problemas de sáude pública no Brasil. Associada à desnutriçäo, a Encefalopatia de Wernicke (EW) provoca seqüelas que podem culminar em demência e/ou morte. Seus efeitos pode, no entanto, ser minorados com medidas de diagnóstico precoce e prevençäo primária. Os autores fazem revisäo do quadro clínico, curso, fisiopatologia e tratamento da EW con ênfase no manejo, prevençäo e evitaçäo de iatrogenia, propondo rotina de atendimento para esses pacientes