ENCEPHALOPATHY

ENCEPHALOPATHY (from Greek encephalon - brain and pathos - suffering), etymologically - a disease depending on damage to the brain. Various authors invest the concept of E. with different content: as E. describe various traumatic, infectious, toxic, associated with damage to the endocrine apparatus diseases of the brain, sometimes even systemic lesions. Symptoms in E. are very diverse depending on etiology and topography of the lesion. Typical groups of symptoms are described as special encephalopathic syndromes. In French literature, under children's E. (term Brissaud) is usually meant all diseases of early childhood, manifesting at birth or immediately after this moment. Only the term encephalopathia saturnina has gained general circulation to denote the disease of the brain in lead poisoning (see Lead). Mercury E. is also described, manifested in a number of neurological and psychiatric symptoms, depending on a diffuse process in the brain with predominant damage in the cerebellum and involvement of the autonomic nervous system. EOSINOPHIL, a white blood cell belonging to the group of granular leukocytes - granulocytes, formed normally in the bone marrow. E. is found in the blood of mammals, amphibians, reptiles, birds and fish. The protoplasm of E. is filled with large grains, intensely staining with acid dyes, including eosin, for which they were named eosinophils by Ehrlich. In humans E. is somewhat larger than a neutrophil: the granularity of a mature normal eosinophil in a fixed smear consists of homogeneous, relatively equal size acidophilic granules (see separate table, fig. 1). In addition, Liebreich discovered in them a small amount of shiny non-staining grains, so-called alpha-granules. The granularity in some immature eosinophilic myelocytes is basophilic. In pathological eosinophils among the eosinophilic granularity, small basophilic granules are often found (see separate table, fig. 2). The nucleus of E. mostly consists of two segments, however nuclei with 4-5 segments are also found, as well as rod-shaped ones. In pathological cases the nucleus of an eosinophil may remain unsegmented and retain a bean-shaped or even round shape (see separate table, fig. 3). - The formation of granularity in leukocytes during life, including in E., is questioned by many authors. By the method of Vonwiller in capillaroscopy with oil immersion, it has not yet been possible to detect granularity in human leukocytes. Saltikov, Nikolaev and others consider eosinophilic grains to be phagocytosed erythrocytes. In a fresh drop and when examined in the dark field, the granularity of eosinophils is coarse, shiny, and strongly refracts light. When E. of humans disintegrates, Charcot-Leyden crystals are obtained. Petri and Neumann subjected the granularity of E. to chemical analysis, according to which it consists of highly organized protein bodies, not containing phosphorus, relatively rich in iron, however without hematin group, and showing extremely great stability with respect to enzymes and various solvents. Muller found in eosinophilic granules from 2% to 4% lipoids. When stained by Zert and Goldman they are stained by Sudan. E. give oxidase, peroxidase and dopa-reaction. The ameboid mobility of E. can be easily detected by treating a blood drop according to Hewerden: slightly spreading a blood drop on a slide, quickly placing it in a moist chamber for 15 min. in an incubator. Then a little formalin is poured into the chamber; after 5 min. the preparation is washed with water and stained. E. are found fixed with the formation of pseudopodia. The same is observed in tissue cultures and when examining with a heated stage. In dogs the granularity in some eosinophils consists of large round formations of various sizes, of which individual ones sometimes fill almost the entire protoplasm (see separate table, fig. 5). In rabbits the leukocytes corresponding to the neutrophilic series of white blood cells of other animals are called pseudo-eosinophils (see separate table, fig. 4). In the protoplasm of pseudo-eosinophils there is fine eosinophilic and coarse basophilic granularity. The latter predominates in immature forms. The number of E. in normal humans fluctuates on average between 2-4%. When the number of E. increases above 6% they speak of eosinophilia, when it decreases below 2% - of eosinopenia (hyper-eosinophilia), and when they are absent in the blood (also when examined in a thick drop) - of aneosinophilia (see Aneosinophilia). E. can completely disappear from the circulating blood, despite the fact that they are found in large numbers in the bone marrow. Blood eosinophilia also does not always coincide with the so-called tissue eosinophilia (e.g. eosinophilic infiltration of the mucous membrane of the bronchi, intestine, eosinophilic infiltration in lymphogranulomatosis, etc.). Eosinophilia is found in various diseases of anaphylactic nature, such as bronchial asthma, hay fever, Quincke's edema, migraine, also with parenteral administration of protein in cases giving the Arthus phenomenon, as well as with increased sensitivity to medicinal or professional chemical substances (insulin, urisol, etc.). Skin diseases, as well as muscle diseases, often give high figures of eosinophilia. Various helminthic diseases, especially trichinosis, cause eosinophilia. Eosinophilia in neuroses is associated with phenomena of irritation of the autonomic nervous system. Among infectious diseases, eosinophilia at the beginning of the disease process is observed, for example, in scarlet fever, while in other infectious diseases eosinophilia is noted in the period of recovery. Individual forms of chronic myelogenous leukemia give extremely high figures of E., usually moderate eosinophilia is observed. Splenectomy often gives prolonged eosinophilia. During liver therapy for pernicious anemia, an increase in the number of E. to very significant figures (30-50%) is often observed.