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Metabolic Encephalopathy: Behind the Name

Metabolic encephalopathy may be the most common diagnosis in consultative acute neurology. The origin of this term is not generally known but can be traced back. The term replaced more commonly used designations such as organic or functional. The term metabolic encephalopathy was originally linked to organ dysfunction but subsequently became more imprecise. When it expanded to include a large number of diseases, it evolved to "metabolic neuronal dysfunction" and soon could not be distinguished from "quiet delirium" and other designations. This vignette summarizes why the terminology has confused more than clarified but also why it will likely stay in the neurologist's vernacular.

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 Chronic “Toxic” Encephalopathy: The Other CTE

Many people are familiar with the medical diagnosis of chronic traumatic encephalopathy or “CTE” which has been associated with repetitive subtle brain injuries such as those which occur among professional football players. But far fewer people know that there is another common use for the CTE acronym based on the medical diagnosis of chronic “toxic” encephalopathy which is associated with repeated exposures to low levels of neurotoxic chemicals found in the workplace and environment.

 Metabolic Encephalopathies

Metabolic encephalopathies (MEs) are a set of neurological disorders caused by underlying systemic illness. There are two broad categories of metabolic encephalopathies: 1) resulting from lack of glucose, O2 or metabolic factors, and 2) due to peripheral organ dysfunction...

Articles of Interest

Acute Encephalopathy Caused by Inherited Metabolic Diseases

Acute encephalopathy is a critical medical condition that typically affects previously healthy children and young adults and often results in death or severe neurological sequelae. Inherited metabolic diseases that can cause acute encephalopathy include urea cycle disorders, amino acid metabolism disorders, organic acid metabolism disorders, fatty acid metabolism disorders, mutations in the thiamine-transporter gene, and mitochondrial diseases.

An Overview of Toxic Metabolic Encephalopathy: An Acquired Brain Injury

Certain conditions lead to increased toxicity levels, increasing your risk of developing TME. Current or previous drug or alcohol abuse could lead to an imbalance in your metabolism, which can lead to an altered mental status. Additional causes of this type of imbalance are dehydration and malnutrition.

Metabolic Encephalopathies

Multiple etiologies may contribute to the clinical picture.2,10 For example, secondary effects of acute renal failure, including acidosis and electrolyte abnormalities, can compound uremic encephalopathy. The most common etiologies of metabolic encephalopathy during COVID-19 hospitalization were sepsis-associated encephalopathy, uremic encephalopathy, and hypoxic-ischemic encephalopathy. ME is a diagnosis of exclusion and must be distinguished from structural injuries such as traumatic brain injury, stroke, or brain tumor, and from various acute confusional states such as alcohol withdrawal, meningitis, encephalitis, or non-convulsive seizures.

Metabolic encephalopathy and metabolic coma

The origin of the term “metabolic encephalopathy” has been attributed to Glaser, who in 1960 described its clinical manifestations in the setting of renal, pulmonary, and hepatic disorders as “acute and chronic disturbances of intellectual performance and motor and sensory activities ranging from mild confusional states to coma”.

Toxic and Metabolic Encephalopathies

Toxic and metabolic encephalopathies are a group of neurological disorders characterized by an altered mental status—that is, a delirium, defined as a disturbance of consciousness characterized by a reduced ability to focus, sustain, or shift attention that cannot be accounted for by preexisting or evolving dementia and that is caused by the direct physiological consequences of a general medical condition.

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Anesthesia Key

Metabolic encephalopathy is a general term used to describe any process that affects global cortical function by altering the biochemical function of the brain. It is the most common cause of altered mental status in the intensive care unit (ICU) setting, either medical or surgical, and is also one of the most treatable. Early recognition of metabolic encephalopathy, therefore, is critical to the management of the ICU patient.

National Library of Medicine

There are two major types of metabolic encephalopathies, namely those due to lack of glucose, oxygen or metabolic cofactors (which are usually vitamin-derived) and those due to peripheral organ dysfunction