Encephalopathy: A Challenge. What does it mean?. “Encephalo”-means Brain “Patho”-means Disease Encephalopathy is “caused by something else” Implies a remote(outside of the CNS) etiology. Symptoms. Alteration in mental status Lethargy Personality changes
Will usually see with Pneumonia or UTI
Usually some underlying Dementia
May treat with anticonvulsants to reduce or halt seizures
May change diet, Sodium Bicarb and/or add nutritional supplements
In severe cases, may need dialysis or organ replacement
Usually will see with poisonings of toxins/chemicals or medicines like lead, pesticides, or cleaning products but could also be from perfumes or air fresheners.
Treatment is mainly immediate removal from the exposure to the toxin
May also put on anticonvulsants or change diet/nutritional supplements
Encephalopathy is always due to an underlying cause.
The development of metabolic encephalopathy may be the first manifestation of a systemic disease-most importantly a diagnosis of Sepsis
Case Summary: Pt. presents to ED 2/27 0700 with AMS, resp distress, hypertensive urgency (HTV cardio and renal disease), ESRD, and CHF secondary to right heart failure. EMS record: 244/124, 223/116, 220/100 in the ER pt. received IV meds Hydralazine: 10 mg IVP, 20 mg IVP, Labetalol 10 mg IVPX2, Cardene 2.5 mg IVP X2,. Consult note states ? malig HTN v CVA. Also Nephro consult states HTN encephalopathy. Dr. Adams "admit to Critical for management and monitoring of HTN". Stroke code called. CT/MRI in ED (-), no repeat. (PN 2/27) TIA/CVA; (Neuro consult 2/27 11:42am) -"mild ptosis R eye...unable to communicate....inarticulate speech...gag blunted....probable CHF diastolic with LV dysfunction"; (PN 2/28) CVA, ; (Neuro consult 2/27 11:42am) - "mild ptosis R eye...unable to communicate....inarticulate speech...gag blunted....probable CHF diastolic with LV dysfunction, possible component of HTV encephalopathy"; (PN Neuro 2/27 8 pm) "language improving....probable dx hypertensive urgency; (PN 2/28 Neuro) All sign&symptoms gone; (PN 2/28 renal) "HWD/Hypertensive urgency"; (3/3 Renal) ? hypertensive encephalopathy . 2 CDS queries: acuity of CHF (no response, no impact for this case), TIA/CVA (responded); (PN 3/3) TIA(coded as TIA).
Discussion: Coding guidelines for possible/probable dx. Definition of terms - CVA: Physician education re: CVA definitions and options: PN 2/28 states MRA/MRI CT negative but pt. documented as having Neuro deficits >1 h after presentation to hospital. Definition of terms: malignant hypertension: Even at these high levels, a hypertensive emergency (i.e., accelerated or malignant HTN) is only diagnosed if this is an acute change and if an optic exam is noted. Both have accelerated HTN and malignant HTN have end organ damage (as in this case) - the only difference is a bulging optic disk. NN doc: to as documentation source to identify status of neuro deficits?
Cathy Lips, CCS