Metal Toxicity, Liver Disease and Neurodegeneration

Butterworth, Roger F.

doi:10.1007/s12640-010-9185-z

Cited by 84 publications

(54 citation statements)

References 36 publications

(33 reference statements)

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“…Like other previous works, the study did not find any changes in copper metabolism and linked the symptoms to the blood ammonia levels. Today there appears to be no question that manganese accumulation, among other less evident disturbances, plays a central role in the physiopathology of AHD [10][11][12]19 . Analysis of 1.5 T and 3.0 T nuclear magnetic resonance images (MRI) of our patients showed three distinct patterns.…”

Section: Discussionmentioning

confidence: 99%

“…Even so, the disease displays a wide spectrum of symptoms, and it is not rare that patients present other signs and symptoms such as choreoathetosis and dystonia 8,9 . In AHD physiopathology, manganese deposition in basal nuclei appears to be a key factor [10][11][12] . Hepatic encephalopathy (HE) is a more comprehensive term and is characterized by neuropsychiatric symptoms as a complication of a liver disease.…”

mentioning

confidence: 99%

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Acquired hepatocerebral degeneration and hepatic encephalopathy: correlations and variety of clinical presentations in overt and subclinical liver disease

Romeiro

Américo

Yamashiro

et al. 2011

Arq. Neuro-Psiquiatr.

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Acquired hepatocerebral degeneration (AHD) and hepatolenticular degeneration can have similar clinical presentations, but when a chronic liver disease and atypical motor findings coexist, the distinction between AHD and hepatic encephalopathy (HE) can be even more complicated. We describe three cases of AHD (two having HE) with different neuroimaging findings, distinct hepatic diseases and similar motor presentations, all presenting chronic arterial hypertension and weight loss before the disease manifestations. The diagnosis and physiopathology are commented upon and compared with previous reports. In conclusion, there are many correlations among HE, hepatolenticular degeneration and AHD, but the overlapping of AHD and HE could be more common depending on the clinical knowledge and diagnostic criteria adopted for each condition. Since AHD is not considered a priority that affects the liver transplant list, the prognosis in AHD patients remains poor, and flow interruption in portosystemic shunts must always be taken into account. Key words: athetosis, chorea, dyskinesias, dystonia, hepatic encephalopathy, hepatolenticular degeneration, hyperkinesis, movement disorders.Degeneração hepatocerebral adquirida e encefalopatia hepática: correlações e variedade de apresentações clínicas na doença hepática evidente e subclínica RESUMO A degeneração hepatocerebral adquirida (AHD) e a degeneração hepatolenticular podem ter apresentações clínicas semelhantes, mas quando uma doença hepática crônica e achados motores atípicos coexistem, a distinção entre AHD e encefalopatia hepática (HE) pode ser ainda mais complicada. Descrevemos três casos de AHD (dois tendo HE) com diferentes achados em neuroimagem, doenças hepáticas distintas e apresentações motoras semelhantes, todos com hipertensão arterial e perda de peso antes das manifestações motoras. O diagnóstico e a fisiopatologia são comentados e comparados com relatos prévios. Concluímos que existem muitas correlações entre HE, degeneração hepatolenticular e AHD, mas a sobreposição de HE e AHD pode ser mais comum dependendo do conhecimento clínico e da acurácia dos critérios diagnósticos adotados para cada enfermidade. Como a AHD não é considerada prioridade na lista de transplante hepático, o prognóstico dos pacientes com AHD permanece ruim, e a interrupção do fluxo nos shunts portossistêmicos deve ser sempre considerada.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Acquired hepatocerebral degeneration and hepatic encephalopathy: correlations and variety of clinical presentations in overt and subclinical liver disease

Romeiro

Américo

Yamashiro

et al. 2011

Arq. Neuro-Psiquiatr.

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“…The clinical and neurophysiological features of patients with slight MEP abnormalities improved after OLT, whereas the patients with a more advanced stage of disease (severe MEPs abnormalities) did not, indicating that subsequent immediate liver transplantation have to be recommended. 37 …”

Section: Portacaval Shuntmentioning

confidence: 99%

Hepatic Myelopathy: Case Report and Review of the Literature

Liao¹,

Yan²,

Wei³

et al. 2015

Liver Res Open J

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Background: Hepatic Myelopathy (HM) is a rare complication of chronic liver disease usually associated with extensive portosystemic shunt of blood, which has been created surgically or has occurred spontaneously, causing progressive spastic paraparesis. Some single cases or short clinical reports describing patients suffering from HM have been published worldwide, but are often scattered. Material and method: One additional case of HM with typical symptoms was presented, and a retrospective survey of the literature in a manner of comprehensive review was undertaken. Results: 46 case reports with 98 patients of HM including ours have been eligibly selected. General information on all cases was summarized. Detailed analysis of the clinical characteristics of HM patients was undertaken. Conclusion: Liver cirrhosis caused by hepatitis B infection and alcoholism is the most frequent causes of HM. Portosystemic shunt which resulted in chronic exposure to toxic substances bypassing the liver play an important role in the pathogenesis. The pathology study consistently disclosed a selective and symmetrical severe loss of myelin in both lateral pyramidal tracts. The predominant neurologic abnormality of HM is the progressive spasticity and weakness in the lower extremities. A typical manifestations, such as triparesis or quadriparesis, sensory deficit, urinary or bladder incontinence and non-pyramidal manifestations such as dysarthria, tremor and ataxia can also occur, which render the disorder more complicated to be diagnosed. Plasma ammonia concentrations were frequently found to be elevated. MEP provides evidence of the early diagnosis of HM and assesses different degrees of neurological involvement. The spinal cord MRI imaging shows no abnormality. Abnormalities of brain magnetic resonance combined with syndrome of brain dysfunction, hepatocerebral degeneration should be taken into consideration. Appending case studies suggest that liver transplantation is a promising therapeutic strategy.

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“…Excess accumulation of these metal by ingestion or inhalation (mostly in working place) (Agency for Toxic Substances and Disease Registry [ATSDR], 2000) can damage the central nervous system (Winder et al, 2010) most likely due to impaired transport or failure of hepatic detoxification mechanisms, what have deleterious effects on cell function and integrity (Butterworth, 2010). It is known that astrocytes have a much higher affinity and capacity for manganese uptake compared to neurons and that exposure to manganese results primarily in alterations of astrocyte morphology and function (Aschner et al, 1992).…”

Section: Manganese and Neurotoxicitymentioning

confidence: 99%