The decerebration syndrome corresponds to an interruption of the brain stem and neocortex, which can be of different severity. In addition to disturbances in wakefulness, there are sensory and motor disturbances. Treatment depends on the primary cause and, in the case of inflammation, corresponds, for example, to administration of anti-inflammatory medication followed by rehabilitation.
What is Decerebration Syndrome?
According to abbreviationfinder.org, the brain stem lies exactly below the so-called neocortex. This is a motor and multi-sensory part of the cerebral cortex that is common to all mammals. Between the brain stem and the neocortex there is a medullary bed that medical professionals call white matter.
It consists of glial cells and myelinated nerve fibers. Myelin is the isolating substance for nervous tissue. Without an isolating myelin sheath, the individual pathways would lose excitation potential into the environment. In this way, action potentials in the brain could not reach their goal without losses. The neocortex and the underlying medullary bed together form the so-called neopallium.
Decerebration syndromes are referred to as demyelinating diseases that break the connection between the neocortex and the brain stem. The functional decoupling of the brain stem and neocortex usually results in a multitude of motor, sensory and consciousness disorders. Depending on the severity of the damage, a coma can occur. Decerebration syndrome is also often referred to as dehirring syndrome.
Causes
There are many causes of decerebration syndromes. The most common cause of decoupling is inflammation of the brain, which can be caused, for example, by autoimmune diseases such as multiple sclerosis. However, bacterial infections can also cause inflammation, which leads to decerebration syndrome.
In addition to inflammatory processes, poisoning can also result in a decline in the myelin, thereby breaking the connection between the neocortex and the brain stem. Decerebration syndromes have also been reported after mechanically severe brain damage. An additional cause can be oxygen deficiency.
Depending on the exact location of the interruption, neurologists differentiate the decerebration syndrome into different variants. Rigid decerebration occurs, for example, when the neocortex and brain stem are interrupted between the ruber nucleus and Deiters nucleus. In rare cases, brain tumors cause interruptions between the neocortex and the brain stem.
Symptoms, ailments & signs
Patients with decentralized syndrome will have different symptoms depending on the location and severity of the interruption. In addition to loss of consciousness and paralysis, eye movement disorders and vegetative dysfunction can be characteristic. Disturbances of wakefulness occur depending on the place of damage and the stage of progression in different degrees.
Possibly there is Sopor with reduced reactivity to stimuli. The loss of wakefulness can extend to a deep coma from which the person concerned can no longer be awakened. In particularly severe cases of decerebration syndrome, we speak of apallic syndrome.
With this clinical picture, the unconscious patient has opened his eyes and responds to stimuli, but can no longer access any cerebral functions. For this reason, instead of focusing on people or objects, those affected look into the void. Reflexes such as the cough and gag reflex are retained because they are controlled by the brain stem. The patient’s sleep-wake rhythm also remains unaffected by the clinical picture.
Diagnosis & course
Neurologists diagnose decerebration syndrome based on clinical symptoms and brain imaging. The slice image shows clearly recognizable lesions between the neocortex and the brain stem, which clinically manifest as a decoupling of the two structures. The detailed diagnosis includes the determination of the degree of severity and the delimitation of or assignment to specific sub-forms such as apallic syndrome, locked-in syndrome or rigorous decerebral rigidity.
The prognosis for patients with deterebration syndrome depends on the primary cause and the size of the lesions. In some cases the symptoms are entirely reversible. If the coma occurs, the prognosis is less favorable. Nonetheless, decerebral syndrome is not to be equated with brain death.
Complications
The complications of decerebration syndrome depend on the cause of the syndrome. In the worst case, they can lead to severe disabilities and motor disorders that limit the patient’s life and everyday life. There are also disturbances of consciousness, in the worst case the patient can fall into a coma.
If the waking consciousness is disturbed, the person concerned can no longer move his eyes and can no longer communicate with other people. The paralysis can also spread to other regions of the body and lead to pain there. Although the movement and fixation of the eyes is disturbed, the patient can still sleep with his eyes closed.
The decerebration syndrome also affects relatives in the form of psychological complaints and depression and can put a heavy strain on their lives. The treatment of decerebration syndrome is causal and depends on the underlying disease. In most cases this takes place with the help of antibiotics. Tumors can be surgically removed.
The other complications, however, depend on the spread of the cancer. In many cases, decerebration syndrome reduces life expectancy.
When should you go to the doctor?
Since the decerebration syndrome can lead to irreversible consequential damage in the patient, treatment is definitely necessary. The person concerned must immediately consult a doctor if paralysis occurs in different parts of the body, which occurs for no particular reason and does not go away on its own. These disorders of sensitivity can also occur after an accident, which must be examined in any case. Furthermore, a loss of consciousness can also indicate this disease.
If there is a loss of consciousness, an emergency doctor should be called. As a rule, however, the patients with decerebration syndrome are in a coma, so that they are dependent on an inpatient stay in a hospital. A doctor should also be consulted if there are sleep problems associated with negative effects on the reflexes. Various examinations are usually necessary to diagnose decerebration syndrome. A general practitioner can order these or identify initial indications of the disease. Whether a treatment is possible cannot be universally predicted.
Treatment & Therapy
Treatment of patients with decentralization syndrome depends on the primary cause of the damage. Acute inflammation is first treated with medication to limit the damage. In the autoimmune disease multiple sclerosis, cortisone is given to contain an acute attack. In the event of intolerance, the autoimmune inflammation can be contained by means of plasmapheresis by removing autoantibodies from the blood.
Bacterial inflammation must also be contained in order not to assume any life-threatening proportions. The drug treatment in this case depends on the pathogen, but often includes the administration of penicillin. In the recent past, neurologists have often combined antibiotic treatments with high cortisone treatments, since cortisone is the only anti-inflammatory drug that can cross the blood-brain barrier.
If the decerebration syndrome is not related to inflammation but to a tumor, the causal treatment is an excision. If the tumor is inoperable, non-invasive measures are used to shrink the tumor. Mechanical damage and brain damage caused by lack of oxygen cannot be treated causally.
The only treatment option in this case is rehabilitation, which also follows the acute phase of inflammation and tumors. Intensive care treatment may be required depending on the severity of the de-hemorrhagic syndrome. In such a case, a tracheal incision is made through which the patient can be connected to a ventilator. A feeding tube may also be required.
Outlook & forecast
The healing of the deterebration syndrome has to be assessed individually. There is a possibility of full recovery in some patients. Others suffer lifelong impairments. The primary cause and the underlying disease are largely responsible for the prognosis of the disease. The extent of the existing lesions and their treatability must be assessed in order to assess the relief of the deterebration syndrome.
Some patients get a favorable prognosis. With them there is a complete regression of the symptoms. The lesions are only light and do not cause permanent tissue damage in the brain. As soon as they are minimized, the symptoms are alleviated. If the patient falls into a comatose state, the prognosis deteriorates significantly. It is to be expected that the deterebration syndrome will not be cured. In addition, however, there may be further impairments or secondary diseases. Suffered brain damage can often not or only with difficulty be treated.
Brain damage caused by a lack of oxygen is particularly unfavorable. They are often irreparable. Cognitive losses or malfunctions of individual systems occur. If the prognosis is unfavorable, the patient needs lifelong care and is unable to cope with everyday life independently. Artificial respiration or nutrition can also be required.
Prevention
The dehirring syndrome can only be prevented to the extent that its causes can be prevented. Since a wide variety of processes can cause a functional disruption of the brain stem and neocortex, there are no promising preventive measures. At most, traumatic severe brain damage in the context of an accident can be prevented to a limited extent.
Aftercare
In the case of decerebration syndrome, the early detection and treatment of this disease is usually in the foreground, so that further complications or, in the worst case, death of the person affected can be prevented. Follow-up care measures are very limited in this disease, so that the person affected is primarily dependent on treatment by a doctor.
The earlier the treatment of the decerebral syndrome is started, the better the further course of this complaint will usually be. Self-healing cannot occur in this syndrome, so treatment is definitely necessary. The treatment itself is usually done with the help of medication that can alleviate the symptoms.
The person concerned should follow the doctor’s instructions. In many cases it is also necessary to take antibiotics, although alcohol should be completely avoided while taking them. In many cases, the antibiotics must be taken for a few days even after the symptoms disappear. Furthermore, regular examinations of the body should be carried out in order to detect tumors at an early stage. The decerebration syndrome may reduce the life expectancy of the person affected.
You can do that yourself
In addition to a serious accident, inflammatory and bacterial disease-related processes as well as autoimmune diseases, multiple sclerosis, cancer and poisoning, such as after a toxic suicide attempt, can trigger decerebration syndrome at any time. Therefore, those affected must be clear about the cause in order to be able to resort to self-help in everyday life as well as possible.
A clean, hygienic environment as well as a sensible diet and the use of prescribed medication are important components in maintaining one’s standard of living for the time being. If the person concerned can be treated with medication, he should seek rehabilitation measures and adapt his lifestyle.
Immediately giving up cigarettes, alcohol and drugs is inevitable and helps people to help themselves. If you are overweight, your diet should also be reconsidered and changed. As long as the patient is able, he can practice quiet exercise such as tai chi, yoga or light gymnastics.
Rather more difficult to cope with as the syndrome progresses is the permanent risk of falling into a vegetative state, especially for patients living alone. It is advisable to strive for assisted living, especially since the course of the disease leads to considerable disabilities in the cognitive and motor areas. Due to the loss of movement and increasing pain, severe attacks of depression develop. Those affected should therefore seek therapeutic measures and supportive help in everyday life for their immediate relatives in good time.
