Encephalopathy in Patients with Cirrhosis of the Liver. A Neuropsychological Study

Elsass, Peter; Lund, Y.; Ranek, L

doi:10.3109/00365527809181755

Cited by 60 publications

(15 citation statements)

References 10 publications

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“…30 There is considerable evidence that patients with cirrhosis, particularly those with evidence of hepatic encephalopathy, exhibit attentional dysfunction, more specifically, deficits of complex attentional skills. [31][32][33][34][35] Their inability to disengage previously focused attention 35 may play a role in their inability to track small moving objects.…”

Section: Discussionmentioning

confidence: 99%

Disruption of smooth pursuit eye movements in cirrhosis: Relationship to hepatic encephalopathy and its treatment

et al. 2005

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Smooth pursuit eye movements (SPEM) are the conjugate movements used to track the smooth trajectory of small dots. Jerky or 'saccadic' ocular pursuit has been reported in patients with cirrhosis, but no formal assessment of SPEM has ever been undertaken. The aim of this study was to evaluate SPEM in patients with cirrhosis and varying degrees of hepatic encephalopathy. The patient population comprised 56 individuals (31 men, 25 women) of mean age 51.1 (range, 25-70) years, with biopsy-proven cirrhosis, classified, using clinical, electroencephalographic, and psychometric variables, as either neuropsychiatrically unimpaired or as having minimal or overt hepatic encephalopathy; patients were further categorized in relation to their treatment status. The reference population comprised 28 healthy volunteers (12 men, 16 women) of mean age 47.3 (range, 26-65) years. SPEM was assessed using an electro-oculographic technique. Visual inspection of the SPEM recordings showed clear disruption of smooth pursuit in the patients with minimal hepatic encephalopathy, and more pronounced disruption, if not complete loss, of smooth pursuit in patients with overt hepatic encephalopathy. The differences observed in quantifiable SPEM indices between the healthy volunteers/unimpaired patients and those with overt hepatic encephalopathy were significant (P < .05). In conclusion, SPEM performance is impaired in patients with hepatic encephalopathy in parallel with the degree of neuropsychiatric disturbance: the pathophysiology of these changes is unknown, but retinal, extrapyramidal, and attentional abnormalities are likely to play a role. Treatment status confounds the classification of neuropsychiatric status and should be taken into account when categorizing these patients. (HEPATOLOGY 2005;42:772-781.)

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Section: Discussionmentioning

confidence: 99%

Disruption of smooth pursuit eye movements in cirrhosis: Relationship to hepatic encephalopathy and its treatment

et al. 2005

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“…These findings have parallels in humans with portacaval shunting. Many patients who showed no obvious neurological abnormalities have intellectual impairment, loss of day-night rhythm, and alterations in EEG and psychomotor function (Rehnstrom et al, 1977;Elsass et al, 1978). In one study a significant reduction in CMRo2, a direct reflection of energy metabolism, was found in the absence ofcoma or somnolence (Posner and Plum, 1960).…”

Section: Discussionmentioning

confidence: 99%

Failure of Glucose and Branched‐Chain Amino Acids to Normalize Brain Glucose Use in Portacaval Shunted Rats

Mans

Davis

Biebuyck

et al. 1986

Journal of Neurochemistry

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Several abnormalities in brain and plasma amino acid concentrations caused by portacaval shunting in rats return toward normal after 4 days of intravenous infusion with either glucose or glucose with branched-chain amino acids. To assess the effect of such treatment on brain energy metabolism, regional brain glucose use was measured using [14C]glucose and autoradiography, 5 weeks after portacaval shunting. In one experiment intravenous glucose or glucose with branched-chain amino acids was given for 4 days. In a separate experiment the treatment was given orally for 2 weeks, and in addition to glucose use, brain monoamines and amino acids were measured. No other food was provided; the rats had free access to water. Normally fed shunted rats and sham-operated rats served as controls. Both types of oral treatment lowered the high concentrations of tyrosine, phenylalanine, and glutamine in plasma and brain. Glucose without amino acids normalized brain tryptophan. Levels of brain norepinephrine, 5-hydroxytryptamine (serotonin), and 5-hydroxyindoleacetic acid were significantly raised after shunting. Treatment had no effect on norepinephrine but the glucose diet brought the indoles into the normal range. In contrast, neither intravenous nor oral treatment affected brain glucose use, which remained depressed by 25-30% in all brain areas examined.

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“…Many patients with a surgically formed portacaval anastomosis or chronic liver disease, which is often accompanied by portal-systemic collateral circulation, develop symptoms of encephalopathy (Sherlock 1961;Victor, 1974;Hoyumpa et al, 1979). These symptoms may range from subtle disturbances in consciousness, mental ability, and motor coordination (Polli, 1971; Rehnstrom et al, 1977;Elsass et al, 1978) to disorientation, stupor, and coma (Plum and Posner, 1972). It might be expected that indices of cerebral energy metabolism, such as cerebral oxygen consumption (CMRO,) and cerebral glucose utilization (CMRglu), would reflect such alterations in brain function.…”

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confidence: 99%

Regional Cerebral Glucose Utilization in Rats with Portacaval Anastomosis

Mans¹,

Biebuyck²,

Davis³

et al. 1983

Journal of Neurochemistry

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Regional cerebral glucose utilization was measured using [2-14C]glucose in rats with an end-to-side portacaval anastomosis. The experiments were conducted in two groups of rats 4 to 8 weeks after portacaval shunting was established. One group was paralyzed and given N2O:O2 (70:30), whereas the other was conscious, unstressed, and unaware of the experiment. In both groups the rate of glucose utilization was decreased in almost all brain structures by an average of 20% after portacaval shunting. The results showed definitively that cerebral energy metabolism was reduced at a time when there were no obvious neurological abnormalities.

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Encephalopathy in Patients with Cirrhosis of the Liver. A Neuropsychological Study

Cited by 60 publications

References 10 publications

Disruption of smooth pursuit eye movements in cirrhosis: Relationship to hepatic encephalopathy and its treatment

Disruption of smooth pursuit eye movements in cirrhosis: Relationship to hepatic encephalopathy and its treatment

Failure of Glucose and Branched‐Chain Amino Acids to Normalize Brain Glucose Use in Portacaval Shunted Rats

Regional Cerebral Glucose Utilization in Rats with Portacaval Anastomosis

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