- 1 Encephalomalacia Definition
- 2 Encephalomalacia Causes
- 3 Encephalomalacia Symptoms
- 4 Encephalomalacia Treatment
- 5 Cystic Encephalomalacia
Encephalomalacia is an extremely serious condition in which parts of the brain are damaged and destroyed. It is sometimes described as being a softening of the brain.
A useful definition is that this is a pathological softening of the brain but this is a very wide definition which does not take into account the many different types and causes of encephalomalacia. The name, like most medical terms is new Latin but is of Greek origin. The prefix “encephalo-” refers to the brain of course and is derived from the Greek “ en kephale” meaning “in head” and the suffix “malacia” is from the Greek word “malakia” which translates as “softness, tenderness or weakness”.
There are various different causes of encephalomalacia but the condition is usually caused by vascular insufficiency or degeneration. The necrosis or death of brain tissue occurs when it is starved of blood such as during a stroke or can be as a result of infection or a traumatic brain injury. The different types of encephalomalacia are frequently described as being red, white or yellow but this use of colour descriptors has little significance to patients and is more relevant to those carrying post mortem examination of lesions in the brain. The colours refer to the appearance of infarcts (wedges of necrotic brain tissue) and a white infarct indicates that this has been caused by being starved of blood such as in an ischaemic stroke. Red infarcts are associated with haemorrhagic (bleeding) incidents such as a haemorrhagic stroke or traumatic brain injury and yellow is found when plaque in the blood vessels is involved.
Encephalomalacia can affect any part of the brain and the part affected does of course influence the nature and severity of the symptoms. In cases where the grey matter is affected, the condition is referred to as polioencephalomalacia and for white matter the term leukoencephalomalacia is used. The frontal, occipital, parietal and temporal lobes of the brain can be affected. The damage to the brain is usually localised to a particular area but can occasionally be more widespread throughout the brain.
There is no escaping the fact that this is an extremely serious condition and the symptoms experienced depend on the part of the brain affected. Damage to the grey matter affects many of the body’s normal functions and typical symptoms include ataxia (a loss of muscular co-ordination and wobbly gait),somnolence (extreme sleepiness), blindness, circling, head pressing and sleep walking. In cases where damage to the frontal lobes has occurred, there may be memory loss and mood swings. The white matter controls many of the body’s functions and connects different parts of grey matter. When this is damaged, the whole body can be affected. Diseases such as multiple sclerosis, Alzheimer’s and various other degenerative conditions can affect the brain’s white matter. The most severe symptoms of Encephalomalacia can lead to the patient falling into a terminal coma.
Unfortunately, at this time, cells of the central nervous system cannot be repaired or regenerated so the damage caused by encephalomalacia must be regarded as permanent and life changing. The extent and location of the damage to the brain is normally assessed using MRI or CT scans and, although there is no treatment for the condition, this information may be helpful in assessing the patient’s potential capabilities in learning to live with this disability. In the future there could possibly be some effective treatments involving the use of stem cells but this is still quite some way off. In some cases surgery may be recommended to help restore some functions or to remove damaged tissue but there are significant risks and the outcome is far from guaranteed. Some adult patients adapt well and go on to lead fulfilling lives but for others the future prospects may remain bleak and there is often a shortened life expectancy. Some newborn children suffer from this condition and their prognosis is poor. They can be expected to have a short life expectancy and many problems throughout their short lives.
Birth is a particularly hazardous time of life and in some cases newborn babies may be subjected to this devastating condition. The most usual cause for encephalomalacia in infants is due to hypoxia (oxygen starvation) and the type of encephalomalacia caused by this is often not restricted to one specific area of the brain, as frequently happens in the case of a minor stroke but manifests itself in the form of multiple areas of damage throughout the white and grey matter. This is usually described as multicystic encephalomalacia but the damaged areas of the brain are in fact pseudo-cysts the damaged areas having a lace-like appearance with many small voids. Another very rare form of cystic encephalomalacia is referred to as giant cavernous cystic encephalomalacia which, as the name suggests, involves large empty cavities in the brain. Infants affected with such a condition would not be expected to survive.
So encephalomalacia remains a major cause of morbidity and mortality. The risks generally increase with age and probably the best advice is to try to lead a healthy lifestyle.