Multimodal MR imaging in hepatic encephalopathy: state of the art

Zhang, Xiao Dong; Zhang, Long Jiang

doi:10.1007/s11011-018-0191-9

Cited by 13 publications

(13 citation statements)

References 101 publications

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“…DTI, which has been used in some research studies, could be performed in this setting in the near future because these sequences are now commonly available and provide important information about pathophysiology (Fig. ) . In addition, DTI is used to more precisely determine the longterm prognosis after acute brain injuries, such as in cases of cardiac arrest or traumatic brain injury …”

Section: How To Assess Neurological or Neurocognitive Complications Omentioning

confidence: 99%

“…This particular indication for LT, which is based on persistent HE that is being adequately treated, has been, until now, based solely on an expert’s evaluation and not on any additional and specific complementary exploration. Some of these patients may have been wrongly diagnosed with HE, which could explain an incomplete recovery after LT. How useful would a multimodal MRI be in this setting? Answering this question would open a door that could provide access to LT only to patients with a major chance of improvement and would restrict access to patients with previously undiagnosed cerebral alterations who have a high probability of decompensation after LT.…”

Section: Future Directionsmentioning

confidence: 99%

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Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

Weiss

Thabut

2019

Liver Transpl

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Orthotopic liver transplantation (LT) remains the only way to definitively cure patients with the most severe liver diseases.Because the survival rate is now fairly high, important questions about neurological sequelae or quality of life after LT have emerged. Indeed, LT represents a peculiar situation because up to 30% of patients present with neurological symptoms after LT compared with only 4% after cardiac transplant and 0.5% after renal transplant. These postoperative neurological symptoms have long been interpreted as sequelae of hepatic encephalopathy (HE). However, postoperative decompensation of an unknown cerebral condition due to the pathophysiology of cirrhosis or undiagnosed neurodegenerative disorders or aging constitute other possibilities that are underrecognized. Some patients who undergo LT for acute liver failure and patients with cirrhosis without episodes of HE and without any previous cerebral alteration also display post-LT neurological symptoms. This latter situation speaks in favor of a direct adverse effect of either general anesthesia, the surgical procedure, or factors related to the postoperative intensive care unit (ICU) environment. The role of inflammation, which has been described in the ICU setting, could also be a crucial determinant. In this review, we will discuss the neurological complications associated with LT, the neurocognitive complications after LT, and how to assess the LT-related neurological or neurocognitive complications. Furthermore, we will review the various hypotheses surrounding post-LT neurocognitive impairment and will conclude with recommendations for future directions.

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Section: How To Assess Neurological or Neurocognitive Complications Omentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

Weiss

Thabut

2019

Liver Transpl

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“…ScanRT investigates the rescue from working memory (ventral‐medial area), that is, the type of memory we use to remember a phone number between reading it and typing it. All such functions are known to be affected by HE, and a reduction in gray matter volume in the implicated anatomical areas has been documented in patients with cirrhosis and HE …”

Section: Discussionmentioning

confidence: 99%

“…All such functions are known to be affected by HE, 41 and a reduction in gray matter volume in the implicated anatomical areas has been documented in patients with cirrhosis and HE. 42 All the computerized tests (sRT, cRT and ScanRT) were performed after a short practice run because unpublished data relating to a previous study from our group 43 had shown that 80 normal controls improved significantly when these tests were repeated. It should however be highlighted that this is a result dating back to 1999, a time when the use of the computers was not as widespread as it is now, especially in people in their 40s-60s.…”

Section: Discussionmentioning

confidence: 99%

The influence of HE history, HE status and neuropsychological test type on learning ability in patients with cirrhosis

Zarantonello

Turco

Formentin

et al. 2019

Liver International

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Background & Aims Learning ability may be impaired in patients with a history of overt hepatic encephalopathy (OHE). The aim of this study was to compare performance on the first/second attempt at a series of tests. Methods Two hundred and fourteen patients with cirrhosis were enrolled. On the day of study, 41% were classed as unimpaired, 38% as having minimal HE and 21% as having mild OHE; 58% had a history of OHE. Performance was compared between two versions of the trail‐making test A (TMT‐A), and between the first/second half of a simple/choice reaction time (sRT and cRT), and a working memory test (ScanRT). Results Both patients with and without OHE history improved in TMT‐A, sRT and ScanRT. Only patients with no OHE history improved in cRT. All patients, regardless of their HE status on the day of study, improved in TMT‐A and sRT. Only patients with mild OHE on the day of study improved in cRT. Only unimpaired patients improved in ScanRT. When OHE history and HE status on the day of study were tested together, only HE status had an effect. The same held true when age, the Model for End Stage Liver Disease (MELD) and educational attainment were adjusted for. Conclusions HE status on the day of study and the type of neuropsychological test had an effect on learning ability in a well‐characterized group of patients with cirrhosis.

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“…So far, brain imaging has provided useful insight into the pathophysiology of HE [20]. Details are also provided in the paper by Butterworth [21] on the pathogenesis of HE in cirrhosis in this Supplement.…”

Section: Imagingmentioning

confidence: 99%

Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles

Weißenborn

2019

Drugs

213

158

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In general, hepatic encephalopathy (HE) is defined as a brain dysfunction caused by liver insufficiency and/or portal-systemic blood shunting. This article relates to the so-called type C HE: that is, HE in patients with liver cirrhosis. It manifests as a wide spectrum of neurological or psychiatric abnormalities, ranging from subclinical alterations, detectable only by neuropsychological or neurophysiological assessment, to coma. Several scales have been developed for grading the extent of HE. The most often used is the West Haven criteria (WHC), which differentiate between four grades of clinically overt HE. Patients with liver cirrhosis without clinically overt symptoms of HE but neuropsychological or neurophysiological findings indicating brain dysfunction are considered to have minimal hepatic encephalopathy (MHE). For simplification, some experts suggest differentiating between covert HE (MHE plus grade I HE according to WHC) and overt HE (WHC grades II–IV). Diagnosis of both MHE and overt HE is hampered by the fact that none of the symptoms of HE or the findings in the various diagnostic measures applied are specific. Thus, a diagnosis of HE or MHE can only be made after exclusion of other possible causes of brain dysfunction.

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Multimodal MR imaging in hepatic encephalopathy: state of the art

Cited by 13 publications

References 101 publications

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

The influence of HE history, HE status and neuropsychological test type on learning ability in patients with cirrhosis

Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles

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