Cerebral hemodynamics in patients with cirrhosis

Öncel, Çağatay; Yılmaz, Mustafa

doi:10.5152/tjg.2016.15446

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…We observed an increase in MCA-RI and MCA-PI in cirrhotic patients that was significantly higher in the subgroup with MHE, similarly to what was previously observed in patients with overt hepatic encephalopathy 10,13,14 . Our study was also the first to assess the RI and PI of the PCA, that were both increased in patients with liver cirrhosis compared to controls, although they were not in patients with MHE compared to those without.…”

Section: Discussionsupporting

confidence: 89%

“…The alteration of cerebral vascular flow has been reported in patients with hepatic encephalopathy, but it is unclear whether this may be the cause or the consequence of the encephalopathy itself 8–12 . Studies are mainly based on nuclear radiology imaging techniques, such as SPECT, PET or Xenon scintigraphy, which are expensive and often not available in smaller centers; there are few published data on the assessment of the cerebral vascular flow by transcranial Doppler ultrasound (TCD) in patients with liver cirrhosis and, among them, in those with hepatic encephalopathy, describing an increase in the resistive and pulsatility indices (RI and PI, respectively) 10,13,14 .…”

Section: Introductionmentioning

confidence: 99%

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Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

Ponziani

Funaro

Lupascu

et al. 2019

Sci Rep

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Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

Ponziani

Funaro

Lupascu

et al. 2019

Sci Rep

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“…Patients with decompensated cirrhosis or HE have a higher risk of cerebral hypoperfusion related with microvascular damage and the ability for autoregulation, which is and important feature for systemic blood pressure sudden changes, particularly hypotension, which can promotes HE [84]. These findings were similar to those reported by two separated groups, one located in Turkey, were 50 decompensated group of cirrhotic patients was compared with 50 healthy volunteers using the same TCD approach [85]; while other in China recruited a healthy control group (n = 40), a cirrhotic without HE group (n = 52), a cirrhotic with MHE group (n = 21) and a cirrhotic with OHE group (n = 19) [86]. Here, in the first case, the authors analyzed the spectra signal derived from the systolic velocity, diastolic Astrocyte Pathophysiology in Liver Disease http://dx.doi.org/10.5772/intechopen.72506 velocity, mean flow velocity (MFV in cm/s), pulsatility, and the resistive indexes (PI = Peak sys-…”

Section: Clinical Data In Osmoregulation and Systemic Infections In Csupporting

confidence: 74%

“…Patients with cirrhosis had a lower MFV compared to control healthy group, while cirrhotic patients had a higher PI and RI values and a positive correlation exists with the model for endstage liver disease (MELD) score and the RI values of patients with ascites, which were higher than those without ascites [85]. In the second case, authors found that mean velocity (V m ), V d , PI, and RI, as well as the serum ammonia levels, were decreased in the group of cirrhotic patients with MHE subject to lactulose treatment, when compared with the placebo group, while a positive correlation was found between ammonia and PI, RI, cognitive test results and V d ; authors propose that cerebral hemodynamics is related with the severity of HE and that lactulose treatment is able to significantly improve this parameter in cirrhotic patients [86].…”

Section: Clinical Data In Osmoregulation and Systemic Infections In Cmentioning

confidence: 93%

Astrocyte Pathophysiology in Liver Disease

Pérez‐Monter¹,

Torre-Delgadillo²

2018

Astrocyte - Physiology and Pathology

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Liver disease is one of the major chronic disabilities around the world. It is known that global casualties are increasing because of virus C infection, alcohol consumption, or nonalcoholic circumstances. One of the main derived comorbidities of liver disease is the hepatic encephalopathy (HE), a severe neuropsychological syndrome derived from the acute or chronic liver disease. A key feature accounting for HE symptoms in cirrhotic patients is brain edema, which is triggered by hyperammonemia. In basal conditions, ammonia can be metabolized in the central nervous system (CNS) by astrocytes, which synthetize glutamine using ammonia and glutamate as substrates. In hyperammonemic conditions, astrocytes synthetize large amounts of glutamine generating a hyperosmotic condition, inducing these cells to become swollen in shape, invoking the characteristic symptom clinically manifested in patients with HE, as brain edema; this condition is regulated by water channels called aquaporins (AQPs) and by other molecules such as myoinositol. Experimental evidence suggests that some small non-coding RNAs may regulate AQPs expression both in vivo an in vitro and that some pharmacological interventions improve cognitive impairment in cirrhotic patients. It is undeniable that astrocytes and the different signaling pathways beneath its plasma membrane play a crucial role in liver disease-derived HE and represent some of the novel pharmacological targets to treat comorbidities of the liver disease.

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Identifying Minimal Hepatic Encephalopathy: A New Perspective from Magnetic Resonance Imaging

Wang,

Yang,

Shang

et al. 2023

Magnetic Resonance Imaging

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Type C hepatic encephalopathy (HE) is a condition characterized by brain dysfunction caused by liver insufficiency and/or portal‐systemic blood shunting, which manifests as a broad spectrum of neurological or psychiatric abnormalities, ranging from minimal HE (MHE), detectable only by neuropsychological or neurophysiological assessment, to coma. Though MHE is the subclinical phase of HE, it is highly prevalent in cirrhotic patients and strongly associated with poor quality of life, high risk of overt HE, and mortality. It is, therefore, critical to identify MHE at the earliest and timely intervene, thereby minimizing the subsequent complications and costs. However, proper and sensitive diagnosis of MHE is hampered by its unnoticeable symptoms and the absence of standard diagnostic criteria. A variety of neuropsychological or neurophysiological tests have been performed to diagnose MHE. However, these tests are nonspecific and susceptible to multiple factors (eg, aging, education), thereby limiting their application in clinical practice. Thus, developing an objective, effective, and noninvasive method is imperative to help detect MHE. Magnetic resonance imaging (MRI), a noninvasive technique which can produce many objective biomarkers by different imaging sequences (eg, Magnetic resonance spectroscopy, DWI, rs‐MRI, and arterial spin labeling), has recently shown the ability to screen MHE from NHE (non‐HE) patients accurately. As advanced MRI techniques continue to emerge, more minor changes in the brain could be captured, providing new means for early diagnosis and quantitative assessment of MHE. In addition, the advancement of artificial intelligence in medical imaging also presents the potential to mine more effective diagnostic biomarkers and further improves the predictive efficiency of MHE. Taken together, advanced MRI techniques may provide a new perspective for us to identify MHE in the future.Level of Evidence3Technical EfficacyStage 2

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Cerebral hemodynamics in patients with cirrhosis

Cited by 4 publications

References 17 publications

Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

Astrocyte Pathophysiology in Liver Disease

Identifying Minimal Hepatic Encephalopathy: A New Perspective from Magnetic Resonance Imaging

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