| Cerebral oedema in minimal hepatic encephalopathy due to extrahepatic portal venous obstruction. | |
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MedLine Citation:
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PMID: 20536718 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Minimal hepatic encephalopathy (MHE) has recently been reported in patients with extrahepatic portal venous obstruction (EHPVO). AIMS: To evaluate brain changes by magnetic resonance studies in EHPVO patients. METHODS: Blood ammonia level, critical flicker frequency (CFF), brain metabolites on 1H-magnetic resonance (MR) spectroscopy and brain water content on diffusion tensor imaging and magnetization transfer ratio (MTR) were studied in 31 EHPVO patients with and without MHE, as determined by neuropsychological tests. CFF and magnetic resonance imaging studies were also performed in 23 controls. RESULTS: Fourteen patients (14/31, 45%) had MHE. Blood ammonia level was elevated in all, being significantly higher in the MHE than no MHE group. CFF was abnormal in 13% (4/31) with EHPVO and in 21% (3/14) with MHE. On 1H-MR spectroscopy, increased Glx/Cr, decreased mIns/Cr, and no change in Cho/Cr were noted in patients with MHE compared with controls. Significantly increased mean diffusivity (MD) and decreased (MTR) were observed in the MHE group, suggesting presence of interstitial cerebral oedema (ICE). MD correlated positively with blood ammonia level (r=0.65, P=0.003) and Glx (r=0.60, P=0.003). DISCUSSION: MHE was detected in 45% of patients with EHPVO while CFF was abnormal in only 13%. ICE was present in 7/10 brain regions examined, particularly in those with MHE. Hyperammonaemia elevated cerebral Glx levels correlated well with ICE. CONCLUSIONS: MHE was common in EHPVO; CFF could identify it only in a minority. ICE was present in EHPVO, particularly in those with MHE. It correlated with blood ammonia and Glx/Cr levels. Hyperammonaemia seems to contribute to ICE in EHPVO. |
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Authors:
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Amit Goel; Santosh Yadav; Vivek Saraswat; Arti Srivastava; M Albert Thomas; Chandra M Pandey; Ramkishore Rathore; Rakesh Gupta |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-06-07 |
Journal Detail:
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Title: Liver international : official journal of the International Association for the Study of the Liver Volume: 30 ISSN: 1478-3231 ISO Abbreviation: Liver Int. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-16 Completed Date: 2010-12-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101160857 Medline TA: Liver Int Country: England |
Other Details:
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Languages: eng Pagination: 1143-51 Citation Subset: IM |
Affiliation:
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Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Ammonia / blood Brain / metabolism Brain Edema / diagnosis*, etiology Constriction, Pathologic / complications, pathology Female Flicker Fusion / physiology Hepatic Encephalopathy / diagnosis*, etiology Humans Magnetic Resonance Imaging Male Portal Vein / pathology* |
| Chemical | |
Reg. No./Substance:
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7664-41-7/Ammonia |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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