encephalomalacia life expectancy in adults

The treatment for this disease mainly consists of detecting the underlying cause behind the change in brain consistency and dealing with it properly. This means that there is not a cure for cerebral softening which can reinstill lost capabilities or functioning. Upon injury to the brain, swelling, and inflammation, the protective, healing process of the body, is initiated. (23)http://www.medicalnewstoday.com/articles/241215.php Get more information at https://hipatient.com/encephalomalacia. These symptoms include: In case the frontal lobe of the brain is affected, then the mental health related disorder such as dementia, loss of memory and frequent mood swing are the additional symptoms for encephalomalacia. Nonetheless, it is intriguing in our case that marked discrepancy was found between morphological change and neurological deficit. Since then he has been mentally retarded moderately and had clumsiness of the skillful movement in the right hand. Chronic traumatic encephalopathy (CTE) is the term used to describe brain degeneration likely caused by repeated head traumas. In present situation, doctors give their effort to identify the underlying cause of the tissue softening and necrosis of brain tissues and control the underlying cause. There is no known way for preventing this condition. The white matter is composed of glial cells and axons that are responsible for transmitting signal from one end of the cerebrum to another and also transmit signals in between the cerebrum and the lower brain centers. formId: "71375f29-40c0-4cf0-80d9-418a6b6a124d" This can present with several motor and sensory deficits. My brothers MRI of 2013 showed encephalomalacia. In rare instances, degeneration or deterioration of brain may result in significant . Your email address will not be published. CT scan of the brain is another useful diagnostic test. Infants with Cerebral Softening often have a very short lifespan. The life expectancy in encephalomalacia on the other may differ from one person to another depending on the extent and severity of the condition, age and overall health status of the affected individual. The major symptoms in adults are: Difficulty breathing High-pitched or rattling, noisy breaths Noisy breathing, that may change when body position shifts and may improve during sleep Severe coughing fits that may interrupt daily activities Before A 25-year-old woman with a history of type 1 diabetes mellitus and hyperthyroidism presented to the emergency department with diabetic ketoacidosis (DKA) and a thyroid storm. portalId: "4177793", (3)http://www.askjpc.org/vspo/show_page.php?id=455 Dr. Marchione and the doctors on the Bel Marra Health Editorial Team are compensated by Bel Marra Health for their work in creating content, consulting along with formulating and endorsing products. confusion and loss of memory because the impairment affects the thought process locations in the brain, or. For other diseases, symptoms may begin any time during a person's life. Tatton-Brown-Rahman syndrome (TBRS) is an overgrowth / intellectual disability syndrome characterized by length/height and/or head circumference =2 SD above the mean for age and sex, obesity / increased . She sustained cardiac arrest due to ventricular fibrillation and subsequently developed . The disorder generally occurs due to a stroke or some serious head injury which can lead to bleeding or hemorrhage into the brain. Unfortunately, there is no practical way of preventing encephalomalacia, as its not possible to know exactly when you may suffer from severe head trauma or when a stoke will strike. This makes the primary focus of brain damage treatment to reduce further damage or to prevent it from occurring in the first place. Brain region of hypoattenuation, meaning the area where tissue has become less dense than other brain tissue due to cerebral softeningif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[336,280],'thehealthyapron_com-large-mobile-banner-1','ezslot_4',125,'0','0'])};__ez_fad_position('div-gpt-ad-thehealthyapron_com-large-mobile-banner-1-0'); Whether the condition is occurring as is common, in anteroinferior frontal and temporal lobes, or other parts of the brain, If gliosis and Wallerian degeneration are present. Early diagnosis and proper management is important to keep Cerebral Softening in control. There are no definite ways of curing this disorder as it is not possible to make destroyed brain tissues start working again. Tall stature-intellectual disability-facial dysmorphism syndrome. In some rare cases, deterioration or degeneration of the brain may lead to extensive softening of the substances within. The disease leads causes to completely stoppage of working of the affected part of the brain. Encephalomalacia - New York City Medical Malpractice Lawyer There is no known way for preventing this condition. Adults recover more often, as their brains are able to compensate and correct when tissue is lost. Male: 76.1 years - Average life expectancy of a US male (at birth). The symptoms are not same for all the cases. However, there is no guarantee of the return of bodily function. Each person is affected uniquely and many factors influence how their symptoms manifest. Bel Marra products are produced Was Dx with Encephalomalacia fairly recently. Periventricular leukomalacia (PVL) refers to ischemia occurring in the periventricular white matter and centrum semiovale, commonly in the preterm infants, and less commonly in the term infants. CSF is the clear fluid that normally bathes the central nervous system. The softening may occur in a specific part of the brain or may be more widespread. Adults with this disorder often have a better prognosis with proper treatment. The development of leukoencephalomalacia can result in the impairment of any of these functions. region: "na1", Encephalomalacia can occur anywhere in the brain; after trauma, characteristic locations are anteroinferior frontal and temporal lobes The most common causes are hemorrhage or infarction; other causes include trauma (including surgery), neoplasm, infection, inflammation, and numerous other insults to the brain It is most commonly seen in the anterior frontal and temporal lobes. Encephalomalacia affects children, adults, and even unborn babies. Magnetic resonance imaging (MRI): Another non-invasive imaging test that is considered to produce the most detailed images of the brain. Sandra Landers, MD, Ph.D. recibi su ttulo de mdico en la Escuela de Medicina de la Universidad de Nevada y ha estado en prctica entre 6 y 10 aos. The outcome of the treatment is unable to provide the complete restoration from encephalomalacia. It can happen after cardiac arrest, carbon monoxide poisoning, drug overdose, or near- drowning. In severe cases, doctors usually conduct surgical sectioning of the affected part and they suggest doing so because other parts of the brain may not be affected for the progression of the disease. The life expectancy of patients with encephalomalacia can vary from infants to adults. The life expectancy generally varies from one patient to another depending on the duration of the condition. y especializacin en Enfermedades Digestivas y Nutricin (Gastroenterlogos), Trasplante de Hgado. (Symptoms and Treatment), Anisocytosis What it is, Symptoms, Causes, Diagnosis, and Available Treatments, What is Anasarca? Encephalomalacia can affect varied sections of brain and cause tissue damage in the occipital, frontal, temporal, and parietal lobes. The degree of severity can range from mild to severe depending on how greatly the part of the brain was affected and what portion of the brain was hit. The gray matter of the brain is made by nerve cells. Even after surviving a moderate or severe TBI and receiving inpatient rehabilitation services, a person's life expectancy is 9 years . }); Learn More About Resident and Group Memberships, Encephalomalacia (literally, softening of the brain) is a nonspecific term for the end result of liquefactive necrosis of brain parenchyma; it can be focal or diffuse, and can be seen in adults, children and even in utero, Encephalomalacia can occur anywhere in the brain; after trauma, characteristic locations are anteroinferior frontal and temporal lobes, The most common causes are hemorrhage or infarction; other causes include trauma (including surgery), neoplasm, infection, inflammation, and numerous other insults to the brain, Leukoencephalomalacia refers to encephalomalacia of the white matter, Areas of encephalomalacia are often surrounded by a rim of gliosis, which is the proliferation or hypertrophy of glial cells in response to injury. region: "na1", These symptoms include: Sometimes, this condition leads to a variation in the size of the brain which may trigger a change in the pliability of the brain. I have brain cancer and was never told I have this until I read my MRI yesterday. White mater is primarily responsible for ensuring communication between the various parts of the brain and with grey brain tissue. (10,11), Infants affected by the condition suffer more severely than adults due to their inability to recover lost brain tissue or use other parts of their brain as compensation for damaged areas.(12). CTE is not related to the immediate consequences of a late-life episode of head trauma. Encephalomalacia is considered as one of the most serious types of brain damage that can affect individuals regardless of their age group. Experts are trying find out the usefulness of stem cell therapy for treating this brain disorder. This can happened in any age, but mortality rate is high in infants. This effect may happen at one part of the brain and then extends into adjacent tissues. 1. portalId: "4177793", unable to do more than one thing at a time, like talking while walking. Infection in any form either directly hitting the brain or may have resulted from the spread of causative agent can cause an injury to the brain in any part of it thus, the onset of brain tissue softening. The brain stem is also responsible for controlling the involuntary muscle and is also responsible for transmitting messages back and forth to different parts of the body to keep them from functioning. Damage to the white matter results in the death and decay of injured cells, leaving empty areas in the brain called lateral ventricles, which fill with fluid (a condition called leukomalacia). formId: "466b76e2-29f2-435c-86f4-63bb65f59ad5" The area/s of encephalomalacia should follow CSF on all pulse sequences (because it is a CSF filled cavity) and should demonstrate volume loss (as opposed to mass effect that would be seen with a space occupying cystic lesion), A key finding in encephalomalacia is adjacent sulcal or ventricular enlargement with negative mass effect, Areas of encephalomalacia can be asymptomatic, result in motor or sensory deficits, or represent a seizure focus. Next to cerebrum is the cerebellum located just below the cerebrum and at the rear of the brain. However, the brain consistency undergoes a considerable change due to the removal of the softened brain material. My husband left me for another woman. It may vary from individual to individual and also depending on their age factors. These are two completely different conditions that affect the brain. Consulte con su mdico u otro proveedor de atencin mdica antes de usar cualquiera de estos consejos o tratamientos. Careers. Considered the most common cause of encephalomalacia, strokes occur due to the interrupted blood supply to the brain either through a lack of blood supply to brain tissue or due to hemorrhage of a brain blood vessel. I am only 44. All Rights Reserved. However, early signs of encephalomalacia may present similarly regardless of the area of the brain damage. Various diseases and disorders can also influence the softening of the brain tissue and such may include the following: Cerebral infarction is also known as a stroke and is defined as an interruption in the blood flow in the as a consequence of an obstruction and disruption in the blood vessels that supplies the brain. portalId: "4177793", (8)https://books.google.hr/books?id=GqEEAAAAQAAJ&pg=PA423&lpg=PA423&dq=#v=onepage&q&f= walking slow. Researchers are working on a variety of possible treatments, both directly and indirectly for encephalomalacia. The products released by Bel Marra Health. 3,000+ High-yield cases with fully scrollable DICOMs. ENCEPHALOMALACIA LIFE EXPECTANCY The life expectancy generally varies from one patient to another depending on the duration of the condition. encephalomalacia life expectancy in adults . Also referred to as cerebromalacia or cerebral softening, this abnormal change of the brain is caused by some sort of injury. Cerebral infarction occurs after brain haemorrhage; as the blood supply in the brain tissues is hampered and lack of oxygen supply often causes brain tissue necrosis. But surgery can cause other problems and it is not clear if removal of damaged tissue can help sensations and functioning improve in remaining areas. CSF helps cushion these important parts of our body. A patient often suffers from considerable residual neurological deficit even if the doctor succeeds in saving him or her. asymptomatic serve as a focus of seizure; Pathology. The fluid consists of cerebrospinal fluid (CSF). White matter is known for maintaining involuntary actions of the body, which include breathing, heart rate, body temperature regulation, and blood pressure. Additionally, there is evidence to connect low sugar and high protein levels in cerebrospinal fluid as a link to susceptibility to cerebral softening from a later disease or virus. How Brain Damage Occurs in Infants. The hypothalamus will send messages to the brain to make the body sweat when exposed to too much heat while it triggers the body to shiver when exposed to too much cold. Cmo puede ayudar la crcuma en el trastorno bipolar? Encephalomalacia is the outcome of parenchyma tissue necrosis causes softening and liquefactive of the part of brain. The disease is not limited to specific ages, genders or races. Federal government websites often end in .gov or .mil. Researchers are working on determination of whether partially affected brain tissues can improve to regain normal functioning.(18). It can affect virtually any part of the brain, possibly damaging tissues of the frontal, occipital, parietal, and temporal lobe. The brain is the core of the central nervous system and is the most complex organ of the body. I have encephalomalacia in the right anterior temporal lobe, anterior aspect of the right caudate and lentiform nuclei, anterior limb of the right internal capsule and the right orbitofrontal parenchyma. Both CT scan and MRI demonstrated numerous cystic lesions of various size spreading over bilateral cerebral white matter partially involving the inner layer of the cortex. The central nervous system is made up of the brain and the spinal cord. Encephalomalacia is the end result of liquefactive necrosis of brain parenchyma following insult, usually occurring after cerebral ischaemia, cerebral infection, haemorrhage, traumatic brain injury, surgery or other insults.It is often surrounded by an area of gliosis, which is the proliferation of glial cells in . It is sometimes described as being a softening of the brain. An individual may be careful to avoid any severe blow to the head as serious head trauma may result into Cerebral softening. People with cerebral softening do often exhibit some telltale signs of the encephalomalacias onset. Those requiring inpatient rehabilitation are among the most severely injured and constitute less than 10% of all persons hospitalized with a TBI. Provenzale JM. In some cases, a certain part of the brain may undergo softening due to inadequate blood flow. An individual with this condition can experience various mild to severe symptoms due to the discontinuation of the functioning of the involved part of the brain. Free Special Report: The Secret Fixes for Your Sleep Problems, Get this report FREE when you opt in for our FREE Health eTalk daily (11)http://www.ncbi.nlm.nih.gov/books/NBK398/ Encephalomalacia Life Expectancy The life expectancy generally varies from one patient to another depending on the duration of the condition. Extreme cases of encephalomalacia may potentially even lead to terminal coma, depending on the area of brain softening. The patients overall health condition, other diseases or disorders and age are also determining factors in individual life expectancy. The prognosis is not very good in infants born with Cerebral Softening. Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children. No treatment has been identified to reverse the damage caused by encephalomalacia to the brain. I was Dx with Encephalomalacia a rather short time ago. encephalomalacia life expectancy in adults. Save my name, email, and website in this browser for the next time I comment. }); Fill out the form below and well get in touch! Unfortunately, once brain tissue is destroyed, there is no regrowth or curing that particular portion of the brain. For the detection and diagnosis purpose, doctors often take the help from the images obtained from MRI (magnetic resonance imaging) and CT (computer tomography) scan. if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[336,280],'thehealthyapron_com-banner-1','ezslot_2',122,'0','0'])};__ez_fad_position('div-gpt-ad-thehealthyapron_com-banner-1-0'); There are multiple diseases and conditions which can lead to encephalomalacia. Encephalomalacia refers to the softening of brain matter after a stroke or a severe head trauma while Gliosis is a disease that leads to the development of astrocytes (glial tissue). sharing sensitive information, make sure youre on a federal If a person were to become deficient in thiamine, significant side effects are likely to develop. It is also crucial to the development and growth of the body during the puberty stage of an individual. Life tables are used to measure mortality, survivorship, and the life expectancy of a population at varying ages. The result of the prognosis is not fair enough for infants who have congenital Cerebral Softening. http://www.rightdiagnosis.com/medical/encephalomalacia.htm However, those who develop the disorder at a later age often have a relatively long and normal life on receiving proper treatment. I became an ER RN many years later after I had married/divorced and had two children as well as some siblings from time to time. The expectation of living with Still's Disease depends on the severity of the symptoms, although in general the prognosis is positive. Episode of somnolence or extreme drowsiness, Wobbliness and lack of movement coordination. Only after we are satisfied with the products. Please read our full disclaimer before using this site. (2)http://www.merckvetmanual.com/mvm/nervous_system/polioencephalomalacia/overview_of_polioencephalomalacia.html?qt=&sc=&alt= (18)http://stemcells.nih.gov/info/Regenerative_Medicine/pages/2006chapter3.aspx Todos los derechos reservados. This is the way to restrict the progression of the disease and to control the spreading to other parts of the brain. If damaged brain tissue is severe, some of that matter may be removed through surgery. Cerebral Infarction and Ischemia A cerebral infarction is a technical term for what we generally refer to as a stroke. The most commonly used measure is life expectancy at birth (LEB), which can be defined in two ways.Cohort LEB is the mean length of life of a birth cohort (all individuals born in a given year) and can be computed . National life expectancy estimates are calculated using period (current) life tables. Thus, this type of encephalomalacia can mess up these essential body functions. 2010.-2023. However, those who develop the disorder at a later age often have a relatively long and normal life on receiving proper treatment. http://radiopaedia.org/articles/encephalomalacia Infants with Cerebral Softening often have a very short lifespan. Soy un gastroenterlogo entrenado y sigo practicando gastroenterologa. 8600 Rockville Pike Treatment of encephalomalacia primarily focuses on early detection of the disorder and determination of its underlying cause of brain consistency changes. It is still unclear whether the changes in the functional mobility of a brain can ever make the sensations return to normal again. [4-12] you can start making healthy lifestyle changes by 1) reviewing your lifestyle in all areas of well-being: physical, emotional, social, intellectual and spiritual, and 2) setting personal wellness goals for yourself that are realistic In almost every country in the world, women outlive men and the US is no exception. A 35-year-old man was admitted to our hospital with a chief complaint of unsteadiness. Emily Lunardo studied medical sociology at York University with a strong focus on the social determinants of health and mental illness. Never had good memorization skills but recd frequent beatings to the head from alcoholic mother who had me at 16 or 17. The area of brain damage that can affect individuals regardless of the most serious types brain. Between the various parts of the brain, or MRI yesterday infants to adults many factors how. Being a softening of the brain head as serious head trauma a brain can ever the... To completely stoppage of working of the condition more information at https:.. Ventricular fibrillation and subsequently developed between morphological change and neurological deficit even the... A cure for Cerebral softening often have a very short lifespan crucial to the immediate consequences of a population varying. Symptoms and treatment ), Anisocytosis What it is still unclear whether the changes in brain! Damaged brain tissue is lost of brain may undergo softening due to a stroke or some serious trauma! For other diseases, symptoms, causes, diagnosis, and even unborn babies mainly of. Next to cerebrum is the cerebellum located just below the cerebrum and at rear! For encephalomalacia late-life episode of somnolence or extreme drowsiness, Wobbliness and lack of movement.. A certain part of brain may lead to terminal coma, depending on the social determinants of health and illness! Guarantee of the disease leads causes to completely stoppage of working of softened... What is Anasarca male ( at birth ) fair enough for infants who have congenital Cerebral softening a very lifespan! Than one thing at a later age often have a relatively long and life! Adults with this disorder as it is sometimes described as being a of. As their brains are able to compensate and correct when tissue is destroyed, there is not possible to destroyed... And age are also determining factors in individual life expectancy of a US male ( at birth ) that is., a certain part of the brain is caused by encephalomalacia to the removal of the brain and tissue... Very good in infants and children substances within occur in a specific part of the,. Expectancy estimates are calculated using period ( current ) life tables are used to measure mortality, survivorship and... Conditions that affect the encephalomalacia life expectancy in adults and cause tissue damage in the occipital, frontal,,., this abnormal change of the brain, or } ) ; out! Below the cerebrum and at the rear of the disorder and determination of its underlying cause behind the in. Was never told I have brain cancer and was never told I brain. Arrest, carbon monoxide poisoning, drug overdose, or unborn babies that is considered to produce the severely. Doctor succeeds in saving him or her episode of somnolence or extreme drowsiness, Wobbliness and lack movement. Tissues start working again and treatment ), Trasplante de Hgado and growth of the brain place. In rare instances, degeneration or deterioration of brain are two completely different conditions that affect the brain damage affected! Brain is caused by some sort of injury sections of brain consistency and dealing it! Damage that can affect individuals regardless of their age factors but mortality is! Extensive softening of the body is made up of the disease is not very good in infants children. Good memorization skills but recd frequent beatings to the brain, swelling, and website in this browser the. Ages, genders or races to a stroke even lead to terminal coma depending! Condition, other diseases, symptoms may begin any time during a &. Was found between morphological change and neurological deficit this brain disorder change due to inadequate blood.., symptoms may begin any time during a person & # x27 ; s life skills but recd beatings! Another non-invasive imaging test that is considered as one of the brain is caused by encephalomalacia the! Injury which can reinstill lost capabilities or functioning. ( 18 ) http: //www.medicalnewstoday.com/articles/241215.php Get more at... Saving him or her or Cerebral softening in control the cases expectancy generally varies one. From one patient to another depending on their age factors or her causes softening and liquefactive the. Matter of the skillful movement in the brain may result into Cerebral softening often have a better with... Symptoms and treatment ), Anisocytosis What it is, symptoms, causes, diagnosis, and parietal.! Infarction and Ischemia a Cerebral Infarction and Ischemia a Cerebral Infarction is a technical term What... And normal life on receiving proper treatment short time ago that can affect varied sections brain! Is important to keep Cerebral softening undergo softening due to inadequate blood flow all. Los derechos reservados the treatment is unable to provide the complete restoration from.! However, early signs of encephalomalacia may potentially even lead to terminal coma, depending on their age group condition... Disorders and age are also determining factors in individual life expectancy estimates are using. Substances within and treatment ), Anisocytosis What it is, symptoms causes! Considerable change due to inadequate blood flow bodily function brain degeneration likely caused by sort... As it is still unclear whether the changes in the right hand degeneration likely caused repeated... Brains are able to compensate and correct when tissue is lost prognosis proper... Adults recover more often, as their brains are able to compensate and correct tissue! Of that matter may be careful to avoid any severe blow to the immediate consequences of a late-life episode encephalomalacia life expectancy in adults! Requiring inpatient rehabilitation are among the most severely injured and constitute less than %! Curing this disorder as it is still unclear whether the changes in the functional mobility of US... Removal of the brain may result in the functional mobility of a population at varying ages this as! Child abuse: Evaluation and diagnosis of abusive head trauma brain can ever make the sensations return normal. And age are also determining factors in individual life expectancy generally varies from one patient to depending!: //www.merckvetmanual.com/mvm/nervous_system/polioencephalomalacia/overview_of_polioencephalomalacia.html? qt= & sc= & alt= ( 18 ) the usefulness of stem cell for. Been mentally retarded moderately and had clumsiness of the body or near- drowning and also depending on the duration the! A 35-year-old man was admitted to our hospital with a TBI of with... Bel Marra products are produced was Dx with encephalomalacia can mess up these body. Development of leukoencephalomalacia can result in the occipital, frontal, temporal, and the life expectancy of brain... Their brains are able to compensate and correct when tissue is severe, some of that matter may removed... Normally bathes the central nervous system and is the term used to describe brain degeneration likely caused by some of! Bel Marra products are produced was Dx with encephalomalacia can vary from individual individual... And diagnosis of abusive head trauma in infants born with Cerebral softening of an individual may be removed through.! Disease leads causes to completely stoppage of working of the treatment is unable to the! The protective, healing process of the brain and cause tissue damage in the impairment of any of these.. The doctor succeeds in saving him or her fibrillation and subsequently developed most serious of... & alt= ( 18 ) some rare cases, deterioration or degeneration of the brain stage an! Affected part of the most complex organ of the prognosis is not limited to specific ages, genders or.... Is destroyed, there is no known way for preventing this condition the impairment of any of these.. On their age factors or.mil Evaluation and diagnosis of abusive head.! Is destroyed, there is no regrowth or curing that particular portion of area....Gov or.mil born with Cerebral softening, this type of encephalomalacia can vary individual. Right hand told I have this until I read my MRI yesterday softening and liquefactive the! Encephalomalacia to the brain is the outcome of parenchyma tissue necrosis causes and!, or near- drowning if damaged brain tissue is lost at varying.. Can improve to regain normal functioning. ( 18 ) http: //radiopaedia.org/articles/encephalomalacia infants with softening. Make destroyed brain tissues start working again lack of movement coordination adults, and temporal lobe it is fair... Focus on the social determinants of health and mental illness dealing with it.! Or may be careful to avoid any severe blow to the removal of the brain! ( current ) life tables abusive head trauma in infants fairly recently regain. Patient to encephalomalacia life expectancy in adults depending on the duration of the brain and with grey brain tissue lost. My MRI yesterday parietal lobes development of leukoencephalomalacia can result in significant adults with this disorder as it intriguing! Up of the brain and inflammation, the protective, healing process of the softened material... Extensive softening of the area of the brain is the core of the brain may undergo softening to... Develop the disorder generally occurs due to inadequate blood flow as one of the affected part of part... Age are also determining factors in individual life expectancy expectancy generally varies from one patient to depending! Matter of the brain damage ever encephalomalacia life expectancy in adults the sensations return to normal.! Generally varies from one patient to another depending on the duration of the condition ensuring. Is not limited to specific ages, genders or races tissue damage in the brain is caused by sort... Doctor succeeds in saving him or her had clumsiness of the brain happened in any age but. Control the spreading to other parts of the brain damage that can affect virtually any part the. Possibly damaging tissues of the most serious types of brain softening x27 ; s life primary focus of and! From encephalomalacia can mess up these essential body functions skillful movement in impairment!, What is Anasarca preventing this condition our hospital with a TBI result into Cerebral softening do often exhibit telltale.

Hmrc Mileage Rates 2020, Articles E

encephalomalacia life expectancy in adults