Hepatic Encephalopathy in Children

Bartlett, Johanna Ascher; Kohli, Rohit

doi:10.1007/s12098-023-04679-6

Cited by 7 publications

(1 citation statement)

References 16 publications

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“…In contrast to other complications, the early stages of neurological abnormalities may exhibit subtle manifestations that could potentially be overlooked. There are few series on neurological involvement, with only a few case reports or reviews available (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Quantitative Brain MRI Signal Differences in Children with Congenital Portosystemic Shunt Based on 3D T1-Weighted Sequence

Zhou,

Guo,

Zhu

et al. 2024

I J Radiol

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Background: Different degrees of T1-weighted (T1W) signal intensities in certain locations on brain magnetic resonance imaging (MRI) are characteristic features of neurological involvement in congenital portosystemic shunt (CPSS). Long-term accumulation of manganese (Mn) as a biomarker can lead to irreversible brain damage. Objectives: The aim of this study was to utilize quantitative brain MRI indicators to characterize brain signal differences in various regions in children with congenital portosystemic shunt. This may contribute to diagnosis, prognosis, and treatment decisions. Patients and Methods: This was a case-control study. Thirty-two patients diagnosed with CPSS based on at least one of the following imaging studies—abdominal ultrasound, Digital Subtraction Angiography (DSA), and Computed Tomography (CT)—and who underwent brain MRI prior to interventional treatment or surgery were included as the Case Group in this study. The age of these patients varied from 22 months to 15 years. Brain MRI of thirty children aged 2 to 15 years, identified without liver or structural diseases, were selected as the Control Group. The brain imaging protocol included an axial spin-echo T1-weighted image (T1WI), an axial T2-weighted image (T2WI), an axial diffusion-weighted imaging (DWI), an axial T2-fluid attenuated inversion recovery (FLAIR) sequence, and a sagittal gradient-echo 3D T1W thin-slice sequence, which can be reconstructed into axial and coronal planes. We utilized quantitative MRI assessment based on the 3D T1-weighted sequence to evaluate intracranial signal differences. The quantitative index was categorized into two types: Globus pallidus-to-frontal subcortical white matter Index (GFI) and anterior pituitary-to-pons Index (API). GFI and API were measured and statistically analyzed on the 3D T1W sequence between the Case Group and the Control Group. GFI of the Case Group was also measured and analyzed between the 3D T1W sequence and the standard T1W sequence. Correlation analysis was applied between the GFI ratios and ammonia levels, as well as between the API ratios and ammonia levels in the Case Group. The duration of the study was more than three months. Results: Significant differences in GFI and API were observed in the Case Group compared with the Control Group (P < 0.01). There was also a statistical difference in GFI between the 3D T1W sequence and the standard T1W sequence (P < 0.01). However, the GFI and API ratios were not correlated with ammonia levels (P > 0.05). The Pearson correlation values were 0.147 and 0.190, respectively. Conclusion: There was a correlation between different brain signals and congenital portosystemic shunt. Quantitative MRI assessment based on the 3D T1-weighted sequence could be used to evaluate these brain signal differences. A longitudinal study with multiple measurements would be beneficial for more accurately assessing such differences, enabling timely interventions, reducing complications, and avoiding lifelong drug therapy.

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Section: Introductionmentioning

confidence: 99%

Quantitative Brain MRI Signal Differences in Children with Congenital Portosystemic Shunt Based on 3D T1-Weighted Sequence

Zhou,

Guo,

Zhu

et al. 2024

I J Radiol

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Intraoperative kidney replacement therapy in acute liver failure

Henderson,

Gupta,

Menon

et al. 2024

Pediatr Nephrol

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Paediatric acute liver failure (PALF) is often characterised by its rapidity of onset and potential for significant morbidity and even mortality. Patients often develop multiorgan dysfunction/failure, including severe acute kidney injury (AKI). Whilst the management of PALF focuses on complications of hepatic dysfunction, the associated kidney impairment can significantly affect patient outcomes. Severe AKI requiring continuous kidney replacement therapy (CKRT) is a common complication of both PALF and liver transplantation. In both scenarios, the need for CKRT is a poor prognostic indicator. In adults, AKI has been shown to complicate ALF in 25–50% of cases. In PALF, the incidence of AKI is often higher compared to other critically ill paediatric ICU populations, with reports of up to 40% in some observational studies. Furthermore, those presenting with AKI regularly have a more severe grade of PALF at presentation. Observational studies in the paediatric population corroborate this, though data are not as robust—mainly reflecting single-centre cohorts. Perioperative benefits of CKRT include helping to clear water-soluble toxins such as ammonia, balancing electrolytes, preventing fluid overload, and managing raised intracranial pressure. As liver transplantation often takes 6–10 h, it is proposed that these benefits could be extended to the intraoperative period, avoiding any hiatus. Intraoperative CKRT (IoCKRT) has been shown to be practicable, safe and may help sicker recipients tolerate the operation with outcomes analogous with less ill patients not requiring IoCKRT. Here, we provide a comprehensive guide describing the rationale, practicalities, and current evidence base surrounding IoCKRT during transplantation in the paediatric population.

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Chronic Liver Disease in Children: From Diagnosis to Liver Transplantation

Gupte,

Srivastava

2024

Indian J Pediatr

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Hepatic Encephalopathy in Children

Cited by 7 publications

References 16 publications

Quantitative Brain MRI Signal Differences in Children with Congenital Portosystemic Shunt Based on 3D T1-Weighted Sequence

Quantitative Brain MRI Signal Differences in Children with Congenital Portosystemic Shunt Based on 3D T1-Weighted Sequence

Intraoperative kidney replacement therapy in acute liver failure

Chronic Liver Disease in Children: From Diagnosis to Liver Transplantation

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