Rare and Unusual … Or Are They? Less Commonly Diagnosed Encephalopathies Associated with Systemic Disease

Abstract

Encephalopathy due to hepatic or renal failure, electrolyte disturbances, or the administration of benzodiazepines and narcotics is commonly encountered, well reviewed in the literature, and, therefore, not usually missed. This article focuses on encephalopathies that were previously well described but may be overlooked by modern clinicians, as well as those that are still taught in the classroom but seldom thought of in practice. Due to the presumed relative rarity of these cases and emphasis on the well-memorized "classic" clinical presentations, these often treatable, and perhaps not so rare, encephalopathies due to systemic medical illness may go undiagnosed and untreated. Pancreatic encephalopathy, Wernicke's encephalopathy, and pellagra encephalopathy are reviewed in detail; cefepime and ifosfamide encephalopathies are discussed as examples of specific medication-induced encephalopathies. Septic encephalopathy, central pontine myelinolysis, and fat embolism syndrome are briefly reviewed. The encephalopathies reviewed have the potential for devastating neurological consequences if recognition and, therefore, treatment are delayed. Clinical improvement for many of these syndromes depends on prompt intervention. This article highlights some representative examples of less-commonly diagnosed metabolic and toxic encephalopathies.

Super-refractory nonconvulsive status epilepticus secondary to fat embolism: A clinical, electrophysiological, and pathological study

“…The neurological symptoms are usually nonlocalizing and range in severity from mild disorientation or changes in mental status to coma [4][5][6]. The majority of patients with FES exhibit symptoms in the first 48 h. The pathophysiological mechanisms of the neurological symptoms appear to be associated with the direct effects of fat emboli on the brain (mechanical theory) and severe hypoxia associated with FES-induced respiratory failure (biochemical theory).…”

Acute necrotizing pancreatitis leading to pancreatic encephalopathy in a patient undergoing long-term continuous ambulatory peritoneal dialysis

“…[8] Pancreatic encephalopathy has the potential for devastating neurological consequences, if recognition and treatment are delayed. [9] Surgery and endoscopic interventions may be necessary and beneficial.…”

Molecular and neurologic responses to chronic alcohol use

“…Common misconceptions about WKS persist, including the idea that it is a rare disease and that it is only a disease seen in alcoholics (Donnino et al, 2007; Weathers and Lewis, 2009). Alcoholism appears to be the most common factor predisposing individuals in the United States to WE; however, WE can occur in any patient with nutritional deficiency (Donnino et al, 2007).…”