Metabolic encephalopathies

In general terms, the clinical features of metabolic encephalopathy are relatively stereotyped.

Usually normal in size and reactive to light.

Symmetrically reduced, associated with hypotonicity

Symmetrically reduced, associated with hypotonicity

- Mental state

Depressed; confusion with impairment of consciousness.

Eye movements

Usually full and conjugate.

Respiratory rate Depressed

These features are characteristic but exceptions occur in specific encephalopathies —

Pupils Eye movements

Hypoxia

Hepatic encephalopathy

Limb movements Hepatic encephalopathy Non-ketotic hyperosmolar coma Hypoglycaemia Uraemia large-reactive small-reactive

Hypoxia (severe)

Hepatic encephalopathy (severe) ^—\ ^—x No movement

- dysconjugate

Hemiparesis can occur

Respiratory rate Hepatic encephalopathy increased

Hepatic encephalopathy 1

Uraemic encephalopathy I Involuntary movements Hypoxia, hypercapnia J ^ ^

Asterixis

-a flapping movement noted ' Myoclonus —a sudden jerk of muscle in the hands when the groups occasionally res-

wrists are hyperextended ulting in limb movement

Beware of the possibility of multiple pathology, e.g. an alcoholic patient with a chronic subdural haematoma may also have liver failure and thiamine deficiency.

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