Encephalomalacia

What is Encephalomalacia?

The human brain is very well protected by the skull, which is a very strong bone, then suspended in cerebrospinal fluid for added protection and has a blood-brain barrier to prevent infections and other pathogens from getting in easily. It is understandable why the brain is so well protected, being the control center of the entire person, but even the most advanced security systems can be bypassed.

Human Brain Lobes

Human Brain Lobes

Encephalomalacia is one such condition, which describes the loss or softening of brain tissue, hence the reason it is also referred to as cerebral softening. The damage to brain tissue is usually localized, and with time it causes scarring as the tissue dies. It is a very serious condition because, depending on the extent of the softening and how it is treated, can lead to permanent brain tissue damage. With the brain tissue damaged, it may leave the individual’s functioning and health compromised, and also it can lead to many complications. [1]

Categories

Encephalomalacia can be categorized into 2 types depending on the part of the central nervous system (CNS) is affected, and these are: [2]

Polioencephalomalacia

This type of encephalomalacia is determined when the damage to the brain affects the gray matter of the CNS. Gray matter gray matter includes all the parts of the CNS that do the actual processing of information, which is why it consists of 40% of the brain and consumes 94% of oxygen in the brain. [4]

Encephalomalacia to the gray matter can therefore, affect essential functions such as speech, muscle control, emotions, memory and even sensory perception.

Leukoencephalomalacia

When softening occurs on the white matter of the brain, this type of encephalomalacia is caused. The white matter of the brain is responsible for ensuring communications throughout the brain tissue, including those from the gray matter to the body. Besides this task, the white matter also keeps involuntary actions working such as breathing and heartbeat, ensuring the body maintains optimal body temperature, blood pressure, etc. When leukoencephalomalacia occurs, one or more of these functions can become impaired, causing difficulty to the individual.

Types

When brain tissue becomes damaged, it then becomes softened, but the extent of the softening can determine the severity of the damage. There are 3 levels of damage, and thus 3 types of encephalomalacia: [5]

Red softening

The region where the softening occurred will cause the brain tissue to become red, and this is because of the supply of blood to an area that previously had none. It is most often observed in hemorrhagic stroke victims, where blood leaks from an artery or capillary and saturates the area.

White softening

Although parts of the brain are referred to as either white or yellow, they still have little color thanks to the presence of blood vessels. If an area of softening is found to be pale or white, this usually shows that there is no supply of blood to that area of the brain, either because the tissue is dead or there is a leak or blockage elsewhere, preventing the supply of blood to the area.

Yellow softening

When brain tissue turns yellow, it is indicative of the build-up of plaque within the arteries of the brain. This type of softening is most commonly observed in victims of trauma.

What causes Encephalomalacia?

The most common cause of cerebral softening is trauma to the head. When a person is in an accident or hit on the head. Brain matter which is suspended in the cerebrospinal fluid is violently thrown toward the inside of the skull where it experiences trauma, just as a person is thrown through the windshield in a car accident. This trauma causes damage to the brain’s tissues and could result in their inflammation, bleeding or destruction. [6]

Besides trauma, the other common cause of encephalomalacia is stroke, which could either be ischemic or hemorrhagic. Ischemic strokes occur when blood flow to a particular part of the brain is restricted, for example, by a blood clot. When a part of the brain is deprived of oxygen, cells and neurons in that area become dead, causing encephalomalacia. Sometimes, even a minor cerebral ischemia can occur which only restricts blood flow, but doesn’t completely cut off supply, but it can still cause cerebral softening. Hemorrhagic strokes, on the other hand, occur when a blood vessel like a capillary or artery bursts or has a leak, causing blood to spill into brain tissue, leading to red softening.

In rare occasions, cerebral softening can also occur due to infection. It is rare because the blood-brain barrier keeps most pathogens away, but some toxins and pathogens do make their way into the brain’s tissues, causing encephalomalacia.

Symptoms

The symptoms of encephalomalacia are varied because they depend on the area of the brain affected by the softening. However, the early signs of encephalomalacia onset are similar regardless of the area affected, and these could be: [7]

  • clumsiness and diminished coordination
  • visual impairment that may be permanent or temporary
  • extreme drowsiness
  • severe headaches
  • head-spinning sensation and vertigo
  • memory loss and mood swings if the frontal lobe is affected

The severity of these symptoms, too, may vary from mild to severe depending on the extent of the damage. In extreme cases, encephalomalacia has been known to lead to a terminal coma in the individual, but it all depends on the area of softening.

Diagnosis and Treatment

Imaging technologies such as MRI and CT scans are used to provide a picture of the brain. The MRI shows which parts of the brain are affected, while the CT scan is used to establish the extent of the damage to brain tissue. [8]

Encephalomalacia Left Temporal Lobe

Encephalomalacia of the Left Temporal Lobe

Unfortunately, there is no cure for encephalomalacia since it is only a state, but the cerebral softening is attended to by repairing the damaged areas. For example, ruptured or blocked blood vessels can be repaired to regain functionality, but these interventions won’t help if the damage is already done. If so, that part of the brain is removed, but there is never a guarantee that the individual will regain full functionality. The prognosis is even worse among infants because their brains won’t develop properly and they will always suffer from neurological deficits.

References:

  1. Introduction to encephalomalacia Available from: https://www.ncbi.nlm.nih.gov/pubmed/22134284
  2. Encephalomalacia categories Available from: http://health-benefits-of.net/encephalomalacia-symptoms-prognosis
  3. Polioencephalomalacia Available from: https://en.wikipedia.org/wiki/Polioencephalomalacia
  4. Grey and white matter facts Available from: http://www.differencebetween.net/science/health/difference-between-grey-and-white-matter/
  5. Types of encephalomalacia Available from: https://en.wikipedia.org/wiki/Cerebral_softening#Types_of_softening
  6. Causes of encephalomalacia Available from: http://health-benefits-of.net/encephalomalacia-symptoms-prognosis
  7. Symptoms of encephalomalacia Available from: http://www.hxbenefit.com/encephalomalacia.html
  8. Diagnosis and treatment Available at: http://healthh.com/encephalomalacia/

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