Document Detail

Neurological and neuropsychiatric syndromes associated with liver disease.
MedLine Citation:
PMID:  16251835     Owner:  NLM     Status:  MEDLINE    
The clinical presentation of acute liver failure and hepatic encephalopathy (HE) in patients with cirrhosis differs significantly. The most serious neurological complication of acute liver failure is the development of devastating brain oedema. Therefore, intracranial pressure monitoring is urgently needed in these patients. Brain oedema is amplified by hypoglycemia, hypoxia and seizures, which are also frequent complications of acute liver failure. Therefore, these parameters must also be monitored. In contrast to acute liver failure in which cerebral dysfunction progresses rapidly, cognitive decline may be clinically undetectable for a long time in cirrhotic patients, until clinically overt symptoms such as psychomotor slowing, disorientation, confusion, extrapyramidal and cerebellar symptoms or a decrease in consciousness occur. Clinically, overt HE is preceded by minimal alterations of cerebral function that can only be detected by neuropsychological or neurophysiological measures, but which nevertheless interfere with the patient's daily living. Rapidly progressing spastic paraparesis (hepatic myelopathy) is a rare complication of cirrhosis. In contrast to HE, it does not respond to blood ammonia lowering therapies but must be considered as an indication for urgent liver transplantation. Cognitive dysfunction has recently been detected in hepatitis C virus (HCV)-infected patients with normal liver function. The patients presented with severe fatigue, cognitive dysfunction and mood disorders. Alterations in brain metabolites, as detected by magnetic resonance spectroscopy, indicated central nervous system alteration in these patients. In contrast to patients with HE, HCV-infected patients did not show motor symptoms or deficits in visual perception, but considerable deficits in attention and concentration ability.
Karin Weissenborn; Martin Bokemeyer; Jochen Krause; Jochen Ennen; Björn Ahl
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  AIDS (London, England)     Volume:  19 Suppl 3     ISSN:  0269-9370     ISO Abbreviation:  AIDS     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-27     Completed Date:  2006-06-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  S93-8     Citation Subset:  IM; X    
Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany.
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MeSH Terms
Hepatic Encephalopathy / diagnosis,  etiology*
Hepatitis C, Chronic / complications
Liver Cirrhosis / complications*,  psychology
Liver Failure, Acute / complications
Mental Disorders / etiology
Spinal Cord Diseases / virology

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