The widening spectrum of neurological damage in liver disease

Williams, Roger; Toghill, P J

doi:10.1136/pgmj.44.508.173

Cited by 10 publications

(4 citation statements)

References 29 publications

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“…Disorders of the cerebellum and extrapyramidal system are not uncommon and patients may present with a clinical picture very similar to that of Parkinson's disease. Less commonly, the corticospinal tract may be involved with hyperreflexia, extensor plantar responses, and hemiparesis (Williams and Toghill, 1968).…”

Section: Discussionmentioning

confidence: 99%

Treatment of chronic hepatic encephalopathy with levodopa

Lunzer¹,

James²,

Weinman³

et al. 1974

Gut

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SUMMARY Three of six patients with chronic hepatic encephalopathy treated with levodopa showed a significant improvement. One patient was probably improved whilst the remaining two patients failed to show any benefit. Serial electroencephalography did not demonstrate significant changes. Treatment with levodopa was associated with an improvement in 'speed-based' tasks as assessed by computerized psychometry. A significant rise in cerebral oxygen consumption was found during levodopa therapy. Gastrointestinal side effects were dose limiting. It is concluded that a therapeutic trial of levodopa in patients with chronic hepatic encephalopathy is indicated when the response to conventional therapy has been poor.

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Section: Discussionmentioning

confidence: 99%

Treatment of chronic hepatic encephalopathy with levodopa

Lunzer¹,

James²,

Weinman³

et al. 1974

Gut

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“…Acute HE is a potentially reversible encephalopathy due to a metabolic disturbance, probably causing widespread alteration in cerebral neurotransmission (1). This should be distinguished from the less-common chronic progressive encephalopathies such as "acquired hepatocerebral degeneration" (2) and the persistent neuropsychiatric syndromes associated with cirrhosis (3). Chronic progressive encephalopathy is characterized by dementia, dysarthria, ataxia, tremor, extrapyramidal signs, and spastic paraparesis (2,4).…”

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confidence: 99%

“…It is more common in patients with large portal-systemic shunts, and usually does not respond to therapy for HE. Structural changes in the central nervous system have been reported in association with this rare, more persistent neuropsychiatric syndrome (2,3). Liver transplantation provides an opportunity to study the extent to which the chronic neuropsychiatric syndrome is reversible.…”

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confidence: 99%

Improvement in chronic hepatocerebral degeneration following liver transplantation

et al. 1990

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Chronic progressive hepatocerebral degeneration with spastic paraparesis, dementia, dysarthria, ataxia, tremor, and neuropsychiatric symptoms follows long-standing portal-systemic shunting, is associated with structural changes in the central nervous system, and does not respond to conventional therapy for hepatic encephalopathy. A case of advanced chronic liver disease with severe, progressive hepatocerebral degeneration after 23 yr of portal-systemic shunting is reported in whom there was significant objective improvement in intellectual function and in the chronic neurological signs 3 mo after orthotopic liver transplantation and further improvement 12 mo after transplantation.

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“…Extra-corporeal circulation of patients' blood through an isolated perfused cadaveric liver (Sen et al, 1966) and heterologous perfusion using pig's liver (Eisman, Liem & Raffucci, 1965) may produce some neurological improvement, but such measures require extensive facilities and have not been used in this country. The neurological syndromes in chronic liver disease During the last 15 years the spectrum of neurological disorders due to chronic liver disease has widened considerably (Williams & Toghill, 1968). Attempts have been made to classify these syndromes into clinical sub-groups (Read et al, 1967) but such (Toghill, Johnstone & Smith, 1967).…”

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confidence: 99%