Neuropsychiatric profile and hyperintense globus pallidus on T1- weighted magnetic resonance images in liver cirrhosis

Krieger, Silke; Jauß, M.; Jansen, Olav; Theilmann, Lorenz; Geissler, M; Krieger, Derk

doi:10.1053/gast.1996.v111.pm8698193

Cited by 123 publications

(77 citation statements)

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“…In addition, the higher level of psychometric and neurophysiological impairment in cirrhotic patients with prior bouts of overt hepatic encephalopathy ties in well with the findings by Krieger et al 8 From this fairly typical population of cirrhotic patients, two kinds of information emerged from the Posner test: the first concerning the visual reaction times (reflecting activity rate, i.e., the velocity of mental processes and motor response linked to arousal 18 ); the second concerning the effect of a cue on visual reaction times (reflecting covert visual attention orienting 21 ).…”

Section: Discussionsupporting

confidence: 85%

Visual attention in cirrhotic patients: A study on covert visual attention orienting

et al. 1998

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Attentional dysfunction, which influences overall cognitive productivity, is not well characterized in cirrhotic patients. The aim of this study was to clarify the features of covert visual attention orienting in cirrhotics without overt hepatic encephalopathy. One hundred consecutive cirrhotic patients and 40 controls were enrolled. Visual covert attention orienting was assessed by the Posner test, which evaluates the effect of a cue on visual reaction times. Patients were characterized by the number connection test (NCT) and electroencephalographic (EEG) spectral analysis. The severity of liver disease was graded using standard laboratory parameters and the Child-Pugh's classification. Fifty-five psychometric and EEG evaluations were performed in the follow-up of 17 patients to assess the relationship between the variations of psychometric and neurophysiological findings. NCT and quantified-EEG parameters (altered in 19% and 40% of cirrhotic patients, respectively) were linked to each other and to the severity of liver disease. The Posner test showed a delay of visual reaction times in class B-C cirrhotic patients. Reaction times were correlated with ammonia and EEG parameters. The effect of the cue was higher in cirrhotic patients than in controls, particularly in the invalid position. This study suggests that cirrhotic patients have a reduced activity rate and reduced capacity to disengage attention previously focused on a cue. Such alterations are linked to NCT and EEG findings. (HEPATOLOGY 1998;27:1517-1523.)Cirrhotic patients have a high prevalence, ranging from 30% to 70%, of subtle cognitive or neurophysiological alterations notwithstanding an almost-normal neurological exam. [1][2][3][4][5][6]

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Section: Discussionsupporting

confidence: 85%

Visual attention in cirrhotic patients: A study on covert visual attention orienting

et al. 1998

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“…Incomplete improvement might be in patients with hepatic myelopahty, acquired hepato-cerebral degeneration. Also there is opinion that after an overt HE bout subtle neurological abnormalities remain (69,70). HE residual changes must be differentiated from intraoperative ischemic brain lesions and persistent portosystemic shunts after liver transplantation, previous stroke, alcohol abuse, trauma, drugs side effects.…”

Section: Liver Transplantationmentioning

confidence: 99%

Diagnosis and treatment of hepatic encephalopathy

Savlan¹,

Liakina²,

Valantinas³

2013

AML

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Background. Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver cirrhosis which symptoms may vary from imperceptible to severe ones. In recent years, there have been some changes of fundamental hepatic encephalopathy pathogenesis and treatment. The early HE on the stage of minimal hepatic encephalopathy (MHE) is rarely diagnosed and treatable condition worldwide and in Lithuania as well, however, this HE stage is responsible for the cognitive disorders which impair the quality of life of cirrhotic patients. According to resent data, MHE can be diagnosed in up to 70% of cirrhotic patients.Aim. To evaluate new diagnostic and treatment strategies for HE and especially MHE for further use in clinical practice to cure the quality of life of cirrhotic patients and prevent clinical manifestation of HE.Methods and materials. This article is based on relevant original publications and reviews in English (1991English ( -2012 that were retrieved by a selective key word based search in the Medline and PubMed databases.Results. It is recommended not to decrease an amount of proteins in food and consume products containing more branched-chain amino acids. Non-absorbable disaccharides (lactulose) are still the drugs of the first choice, though recent data show significant concerns about their effectiveness. Rifaximin is increasingly used all over the world for hepatic encephalopathy treatment. Other drugs for HE treatment are of secondary importance. Lactulose, probiotics are recommended for minimal hepatic encephalopathy treatment.Diagnosis, especially of minimal hepatic encephalopathy, remains complicated. There are no reliable and validated blood indicators to establish minimal hepatic encephalopathy diagnosis, and to follow up treatment efficacy. Psychometric and neurophysiologic methods, visualisation methods are used more in scientific researches. Computerized methods, such as inhibitory control and critical flicker frequency tests, are also promising.Conclusions. Further studies are necessary to design proper algorithms of hepatic encephalopathy diagnostic and treatment.

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“…Pallidal signal hyperintensity on magnetic resonance imaging (MRI) has been observed in a majority of cirrhotic patients (Figure 1; Krieger et al, 1996;Pujol et al, 1993;Spahr et al, 1996). Such images could theoretically be caused by lipid deposition, calcification, melanin, methemoglobin or manganese.…”

Section: Evidence For Brain Manganese Overload In Chronic Liver Diseasesmentioning

confidence: 99%

“…Studies attempting to correlate neurological symptoms with MR imaging used as an index of brain manganese content have so far yielded conflicting results (Krieger et al, 1996;Kulisevsky et al, 1992;Spahr et al, 1996;Spahr et al, 1998;Taylor-Robinson et al, 1995;Weissenborn et al, 1995). This is not surprising because MRI provides only a semi-quantitative estimate of brain manganese concentration.…”

Section: Relationship Between Brain Manganese Accumulation and Neurolmentioning

confidence: 99%

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Spahr

et al. 1998

Metabolic Brain Disease

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Amongst the potential neurotoxins implicated in the pathogenesis of hepatic encephalopathy, manganese emerges as a new candidate. In patients with chronic liver diseases, manganese accumulates in blood and brain leading to pallidal signal hyperintensity on T1-weighted Magnetic Resonance (MR) Imaging. Direct measurements in globus pallidus obtained at autopsy from cirrhotic patients who died in hepatic coma reveal 2 to 7-fold increases of manganese concentration. The intensity of pallidal MR images correlates with blood manganese and with the presence of extrapyramidal symptoms occurring in a majority of cirrhotic patients. Liver transplantation results in normalization of pallidal MR signals and disappearance of extrapyramidal symptoms whereas transjugular intrahepatic portosystemic shunting induces an increase in pallidal hyperintensity with a concomitant deterioration of neurological dysfunction. These findings suggest that the toxic effects of manganese contribute to extrapyramidal symptoms in patients with chronic liver disease. The mechanisms of manganese neurotoxicity are still speculative, but there is evidence to suggest that manganese deposition in the pallidum may lead to dopaminergic dysfunction. Future studies should be aimed at evaluating the effects of manganese chelation and/or of treatment of the dopaminergic deficit on neurological symptomatology in these patients.

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Neuropsychiatric profile and hyperintense globus pallidus on T1- weighted magnetic resonance images in liver cirrhosis

Cited by 123 publications

References 4 publications

Visual attention in cirrhotic patients: A study on covert visual attention orienting

Visual attention in cirrhotic patients: A study on covert visual attention orienting

Diagnosis and treatment of hepatic encephalopathy

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