Bright basal ganglia in T1-weighted magnetic resonance images are frequent in patients with portal vein thrombosis without liver cirrhosis and not suggestive of hepatic encephalopathy

Nolte, W.; Wiltfang, Jens; Schindler, Christian; Unterberg, Knut; Finkenstaedt, Michael; Niedmann, Paul Dieter; Hartmann, H A; Ramadori, Giuliano

doi:10.1016/s0168-8278(98)80063-9

Cited by 47 publications

(35 citation statements)

References 30 publications

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“…Moreover, portal-systemic shunting may increase manganese levels and its accumulation in the brain. 32,33 Neither relationship was confirmed in our study. In fact, the number of patients with pallidal hyperintensity was similar among the patients with and without spontaneous shunts (4 vs. 6, respectively).…”

Section: Discussioncontrasting

confidence: 40%

High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: A case-control study

et al. 2005

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Large spontaneous portal-systemic shunts have been occasionally described in patients with cirrhosis. This study was undertaken to assess the prevalence of portal-systemic shunts in patients with cirrhosis with recurrent or persistent hepatic encephalopathy (HE) as compared with patients with cirrhosis without HE. Fourteen patients with cirrhosis with recurrent or persistent HE (cases) and 14 patients with cirrhosis without previous or present signs of overt HE matching for age and degree of liver failure (controls) were studied. Each patient underwent neurological assessment and cerebral magnetic resonance (MR) imaging to exclude organic neurological pathological conditions. HE evaluation included psychometric performance (Trail-Making Test A), electroencephalogram (EEG), mental status examination and grading, arterial, venous, and partial pressure of ammonia determination. The presence of portal-systemic shunts was assessed by portal venous phase multidetector-row spiral computed tomography (CT). Large spontaneous portal-systemic shunts were detected in 10 patients with HE and in only 2 patients without HE (71% vs. 14%; chi square ‫؍‬ 9.16; df ‫؍‬ 1.0; P ‫؍‬ .002). The patients with HE presented ascites (P ‫؍‬ .002) and medium/large esophageal varices (P ‫؍‬ .02) less frequently than the control group. In conclusion, our study suggests that large spontaneous shunts may often sustain the chronicity of HE; the presence of large shunts should be sought in patients with cirrhosis with recurrent or persistent HE.

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Section: Discussioncontrasting

confidence: 40%

High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: A case-control study

et al. 2005

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“…High pallidal signals have also been observed in patients with long standing portal-systemic shunt alone, due to portal vein thrombosis, without liver cirrhosis 23) . Animal models of portal-systemic shunt without cirrhosis have higher concentrations of Mn in the basal ganglia than in animal models of cirrhosis 24) .…”

Section: Discussionmentioning

confidence: 97%

High Pallidal T1 Signal is Rarely Observed in Obstructive Jaundice, but is Frequently Observed in Liver Cirrhosis

Bang

Choi

Park

et al. 2007

Journal of Occupational Health

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“…Our results are in accordance with a prior study that applied conventional brain MR imaging and found an increase in T1 signal at the level of basal ganglia in 5 of the 6 patients that were included. 29 Because they did not exhibit clinical signs of hepatic encephalopathy, the authors proposed that T1 hyperintensity was not involved in the pathogenesis of hepatic encephalopathy. Additional studies in patients with cirrhosis corroborated the lack of association between T1 hyperintensity and cognitive manifestations of hepatic encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Noncirrhotic portal vein thrombosis exhibits neuropsychological and MR changes consistent with minimal hepatic encephalopathy

et al. 2006

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Hepatic encephalopathy can arise from portal-systemic shunting in the absence of intrinsic liver disease. However, there are few descriptions of this form of encephalopathy. Portal vein thrombosis is an infrequent disease that causes portal-systemic shunting. Episodic hepatic encephalopathy has been described in patients with portal vein thrombosis, but it is not known if these patients develop minimal hepatic encephalopathy. We designed a study to investigate the neurological consequences of portal vein thrombosis in patients without cirrhosis and no clinical signs of encephalopathy. For this purpose, 10 patients underwent neuropsychological tests, an oral glutamine challenge test, and brain magnetic resonance (MR) imaging. The results were compared with those obtained in 10 healthy controls. Patients with portal vein thrombosis exhibited abnormalities in the results of neuropsychological tests, oral glutamine challenge test, and MR similar to those described in hepatic encephalopathy associated with cirrhosis. MR spectroscopy revealed a decrease in myo-inositol and an increase in glutamine. The increase in glutamine correlated with an increase in ammonia following the oral glutamine challenge test, signs of increased brain water (decrease in magnetization transfer ratio), and impairment of attention tests. In conclusion, patients with noncirrhotic portal vein thrombosis develop subclinical neurological abnormalities compatible with minimal hepatic encephalopathy. These disturbances, which include signs of increase in brain water and a compensatory osmotic response (decrease in brain myo-inositol), appear to be secondary to brain exposure to ammonia induced by portal-systemic shunting.

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Bright basal ganglia in T1-weighted magnetic resonance images are frequent in patients with portal vein thrombosis without liver cirrhosis and not suggestive of hepatic encephalopathy

Cited by 47 publications

References 30 publications

High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: A case-control study

High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: A case-control study

High Pallidal T1 Signal is Rarely Observed in Obstructive Jaundice, but is Frequently Observed in Liver Cirrhosis

Noncirrhotic portal vein thrombosis exhibits neuropsychological and MR changes consistent with minimal hepatic encephalopathy

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