Chronic Porto-Hepatic Encephalopathy

Choreoathetosis in porto-systemic encephalopathy.

“…The changes in the brain in case 1 were maximal in the deeper layers of the cortex, but present to a varying extent in one cerebellar peduncle, the inferior olive, and the basal ganglia. Their distribution is thus essentially similar to that described by Baltzan, Olszewski, and Zervas (1957), Gibson (1963), and Victor et al (1965) in other cases of this syndrome. These reports, however, all emphasize the spongy change in neural tissue.…”

Leucoencephalopathy after portacaval anastomosis in a patient with hepatic cirrhosis

“…In the present case, tests of hepatic function showed no abnormality before portacaval anastomosis (though severe portal cirrhosis was evident at operation and on biopsy) and, as in the case of Baltzan et al (1957), showed no measurable deterioration till shortly before death. No evidence of Wilson's disease or haemosiderosis was found in life or after death.…”

“…Status spongiosus may be seen in the brain in hepato-lenticular degeneration (Barnes and Hurst, 1926;Leigh and Card, 1949) and in hepatic cirrhosis and portal hypertension in which large portalsystemic shunts have formed naturally (Baltzan, Olszewski and Zervas, 1957) or been made surgically (Gibson, 1963). At necropsy in the case reported by Baltzan and his colleagues there was an occlusion of the portal vein with a big anastomotic vein in the place of the coronary vein; cirrhotic changes in the liver were not striking.…”

Acquired hepatocerebral degeneration: report of an atypical case

“…This takes the form of a slowly progressive neurological illness characterized by an encephalopathy and irreversible changes within the central nervous system. It is found in patients with chronic liver disease and an extensive portosystemic collateral circulation or with a portosystemic anastomosis (Baltzan et al, 1957;Gibson, 1963;Victor et al, 1965;Sherlock, 1968).…”

“…The commonest neurological disorder is a reversible encephalopathy-namely, hepatic precoma and coma. It is also recognized that there may be permanent damage to the brain (Baltzan, Olszewski, and Zervas, 1957;Gibson, 1963;Victor, Adams, and Cole, 1965;Read et al, 1967). The most comprehensive clinical, biochemical and pathological study has been carried out by Victor et al (1965) who concluded from a series of 27 cases that there was a chronic and largely irreversible syndrome of remarkable neurological and neuropathological constancy associated with acquired liver disease and/or porto-systemic shunts.…”