Document Detail


MRI findings in chronic hepatic encephalopathy depend on portosystemic shunt: results of a controlled prospective clinical investigation.
MedLine Citation:
PMID:  9252084     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: Deterioration of hepatic encephalopathy is a major concern with the transjugular intrahepatic portosystemic shunt procedure. Symmetric hyperintense globus pallidus on T1-weighted cranial magnetic resonance imaging in patients with liver cirrhosis anticipates hepatocerebral disease. It is hypothesized that hepatic encephalopathy and basal ganglia signal intensity progress in patients with cirrhosis of the liver undergoing transjugular intrahepatic portosystemic shunt. METHODS: Twenty-four patients were randomized to undergo either transjugular intrahepatic portosystemic shunt or elective sclerotherapy. At study entry and 6 months after randomization, neurologic assessment, psychometric tests, standard EEG, and magnetic resonance imaging were performed. The severity of liver failure was graded using Child-Pugh's classification. The signal intensity of the globus pallidus was determined on sagittal T1-weighted magnetic resonance imaging. RESULTS: The T1-weighted signal intensity of the globus pallidus on magnetic resonance imaging significantly increased after transjugular intrahepatic portosystemic shunt placement (p<0.01), but not with elective sclerotherapy. At follow-up, neurological symptoms indicating decline of mental status and motor performance were somewhat more prevalent in transjugular intrahepatic portosystemic shunt patients. Significant deterioration of EEG abnormalities occurred in patients treated with transjugular intrahepatic portosystemic shunt as opposed to elective sclerotherapy (p<0.01). CONCLUSIONS: Transjugular intrahepatic portosystemic shunt procedure increases hyperresonant globus pallidus on magnetic resonance imaging. Neuropsychiatric evaluation shows advancing hepatic encephalopathy, in particular with transjugular intrahepatic portosystemic shunt; however, it does not parallel the augmentation of pallidal signal intensity on magnetic resonance imaging.
Authors:
S Krieger; M Jauss; O Jansen; A Stiehl; P Sauer; M Geissler; L Theilmann; D Krieger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of hepatology     Volume:  27     ISSN:  0168-8278     ISO Abbreviation:  J. Hepatol.     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-09-25     Completed Date:  1997-09-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  121-6     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Ruprecht Karls University of Heidelberg Medical School, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Brain / pathology
Chronic Disease
Electroencephalography
Esophageal and Gastric Varices / surgery,  therapy
Female
Follow-Up Studies
Gastrointestinal Hemorrhage / surgery,  therapy
Hepatic Encephalopathy / etiology,  pathology*,  physiopathology
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuropsychological Tests
Portasystemic Shunt, Transjugular Intrahepatic / adverse effects*
Prospective Studies
Sclerotherapy / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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