Division of Neurocritical Care and Hospital Neurology, Mayo Clinic, Rochester, Minnesota, USA.
J Intern Med. 2022 Dec;292(6):846-857. doi: 10.1111/joim.13538. Epub 2022 Jul 9.
Metabolic derangements, when acute and severe, affect brain function. This presents mostly with a marked decline in the level of consciousness, resulting in impaired responsiveness, abnormal receptivity, impaired content, and loss of memory retention. The term metabolic encephalopathy has been used but is conjecture that can be challenged in the age of modern neuroimaging. We now recognize that many metabolic encephalopathies may involve structural lesions and at an early stage. Common clinical conundrums are the evaluation of the degree of brain injury and its recoverability. This review discusses the appropriate terminology for these conditions, the diagnostic approach, therapy recommendations, and prediction of recovery potential. In evaluating a presumed metabolic cause for encephalopathy, we must (1) search for and rule out structural injury to the brain despite an obvious explanatory metabolic derangement, (2) recognize that several confounding conditions often co-exist, and (3) acknowledge that resolution of brain dysfunction may be protracted despite normalization of laboratory values.
代谢紊乱，当急性且严重时，会影响大脑功能。这主要表现为意识水平显著下降，导致反应能力受损、异常接受能力、内容受损和记忆保留丧失。虽然使用了代谢性脑病这个术语，但在现代神经影像学时代，这一概念可能会受到质疑。我们现在认识到，许多代谢性脑病可能涉及结构病变，而且在早期阶段就可能涉及。常见的临床难题是评估脑损伤的程度及其可恢复性。本文讨论了这些情况的适当术语、诊断方法、治疗建议以及恢复潜力的预测。在评估疑似代谢性脑病时，我们必须：（1）尽管存在明显的代谢紊乱，但仍要寻找并排除脑结构性损伤；（2）认识到几种混杂情况经常同时存在；（3）承认尽管实验室值正常化，但脑功能障碍的解决可能会很漫长。
