Minimal hepatic encephalopathy: clinical, neurophysiological, neuroimaging markers
P. I. Kuznetsova,
A. A. Raskurazhev,
S. N. Morozova,
I. M. Lovchev,
M. S. Novruzbekov,
M. M. Tanashyan https://doi.org/10.30629/2658-7947-2023-28-5-21-27
Abstract
Hepatic encephalopathy in the initial stages is a diagnostically challenging clinical phenomenon, based on the accumulation of ammonia. Symptoms of encephalopathy are extremely varied: from a slight cognitive decrease and minimal affective disorders to disorders of consciousness and coma in the terminal stages. However, the severity of liver pathology and neurophysiological and neuroimaging data do not always correlate with the severity of encephalopathy. The greatest difficulties in diagnosis arise at the initial stage of the disease, and a timely recognized and established diagnosis can not only slow down the progression of cognitive deficits and characterological changes, but also significantly improve the patient’s prognosis.
About the Authors
P. I. Kuznetsova
Research Center of Neurology
Russian Federation
Russian Federation
Kuznetsova Polina I.
Moscow.
A. A. Raskurazhev
Research Center of Neurology
Russian Federation
Russian Federation
Moscow.
S. N. Morozova
Research Center of Neurology
Russian Federation
Russian Federation
Moscow.
I. M. Lovchev
Research Center of Neurology
Russian Federation
Russian Federation
Moscow.
M. S. Novruzbekov
N.I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Moscow.
M. M. Tanashyan
Research Center of Neurology
Russian Federation
Russian Federation
Moscow.
References
1. Lu K., Zimmermann M., Görg B., Bidmon H.J., Biermann B. et al. Hepatic encephalopathy is linked to alterations of autophagic flux in astrocytes. EBioMedicine. 2019;48:539–553. doi:10.1016/j.ebiom.2019.09.058
2. Hahn M., Massen O., Nencki M., Pavlov I. Die Eck’sche fistel zwischen der unteren hohlvene und der pfortader und ihre folgen fur den organismus. Arch Exp Pathol Pharm. 1893;32:161–210.
3. Sherlock S., Summerskill W.H.J., White L.P., Phear E.A. Portalsystemic encephalopathy. Neurological complications of liver disease. Lancet. 1954;267:453–457.
4. Amodio P. Hepatic encephalopathy: historical remarks. J Clin Exp Hepatol. 2015;5(Suppl 1):S4–6. doi: 10.1016/j.jceh.2014.12.005
5. Córdoba J. New assessment of hepatic encephalopathy. J Hepatol. 2011;54(5):1030–40. doi: 10.1016/j.jhep.2010.11.015
6. Kuznetsova P.I., Tanashyan M.M., Kornilova A.A. Toxic encephalopathy in polycythemia vera (clinical case). Bulletin of Siberian Medicine. 2019;18(4):249–255. (In Russ). https://doi.org/10.20538/1682-0363-2019-4-249-255
7. Peng J.K., Hepgul N., Higginson I.J., Gao W. Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis. Palliat Med. 2019;33(1):24–36. doi: 10.1177/0269216318807051
8. Tapper E.B., Parikh N.D. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 2023;329(18):1589–1602. doi: 10.1001/jama.2023.5997
9. Xiao G., Ye Q., Han T., Yan J., Sun L., Wang F. Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis. Hepatol Res. 2018;48(3):E275–E282. doi: 10.1111/hepr.12981
10. Eftekar M. The association between hepatic encephalopathy/minimal hepatic encephalopathy and depressive and anxiety disorders: a systematic review. Australas Psychiatry. 2020;28(1):61–65. doi: 10.1177/1039856219875054
11. Shah N.M., Malhotra A.M., Kaltsakas G. Sleep disorder in patients with chronic liver disease: a narrative review. J Thorac Dis. 2020;12(Suppl 2):S248–S260. doi: 10.21037/jtd-cus-2020-012
12. Hardeland R. Melatonin metabolism in the central nervous system. Curr Neuropharmacol. 2010;8(3):168–81. doi: 10.2174/157015910792246244
13. Chojnacki C., Wachowska-Kelly P., Błasiak J., Reiter R.J., Chojnacki J. Melatonin secretion and metabolism in patients with hepatic encephalopathy. J Gastroenterol Hepatol. 2013;28(2):342–7. doi: 10.1111/jgh.12055
14. Velissaris D., Karamouzos V., Polychronopoulos P., Karanikolas M. Chronotypology and melatonin alterations in minimal hepatic encephalopathy. J Circadian Rhythms. 2009;7:6. doi: 10.1186/1740-3391-7-6
15. Cordoba J., Steindl P., Blei A.T. Melatonin arrhythmia is corrected after liver transplantation. Am J Gastroenterol. 2009;104(7):1862–3. doi: 10.1038/ajg.2009.171
16. Harding E.C., Franks N.P., Wisden W. The Temperature Dependence of Sleep. Front Neurosci. 2019;13:336. doi: 10.3389/fnins.2019.00336
17. Kräuchi K., Cajochen C., Werth E., Wirz-Justice A. Warm feet promote the rapid onset of sleep. Nature. 1999;401(6748):36–7. doi: 10.1038/43366
18. Garrido M., Saccardo D., De Rui M., Vettore E., Verardo A., Carraro P., Di Vitofrancesco N., Mani A.R., Angeli P., Bolognesi M., Montagnese S. Abnormalities in the 24-hour rhythm of skin temperature in cirrhosis: Sleep-wake and general clinical implications. Liver Int. 2017;37(12):1833–1842. doi: 10.1111/liv.13525
19. Bosoi C.R., Rose C.F. Oxidative stress: a systemic factor implicated in the pathogenesis of hepatic encephalopathy. Metab Brain Dis. 2013;28:175–8.
20. Jayakumar A.R., Norenberg M.D. Hyperammonemia in Hepatic Encephalopathy. J Clin Exp Hepatol. 2018;8(3):272–280. doi: 10.1016/j.jceh.2018.06.007
21. Chen Z., Ruan J., Li D., Wang M., Han Z., Qiu W., Wu G. The Role of Intestinal Bacteria and Gut-Brain Axis in Hepatic Encephalopathy. Front Cell Infect Microbiol. 2021;10:595759. doi: 10.3389/fcimb.2020.595759
22. Perazzo J.C., Tallis S., Delfante A., Souto P.A., Lemberg A., Eizayaga F.X., Romay S. Hepatic encephalopathy: An approach to its multiple pathophysiological features. World J Hepatol. 2012;4(3):50–65. doi: 10.4254/wjh.v4.i3.50
23. Josephs K.A., Ahlskog J.E., Klos K.J., Kumar N., Fealey R.D., Trenerry M.R., Cowl C.T. Neurologic manifestations in welders with pallidal MRI T1 hyperintensity. Neurology. 2005;64(12):2033–9. doi: 10.1212/01.WNL.0000167411.93483.A1
24. Kaplan P.W., Rossetti A.O. EEG patterns and imaging correlations in encephalopathy: encephalopathy part II. J Clin Neurophysiol. 2011;28(3):233–51. doi: 10.1097/WNP.0b013e31821c33a0
25. Karanfi lian B.V., Park T., Senatore F., Rustgi V.K. Minimal Hepatic Encephalopathy. Clin Liver Dis. 2020;24(2):209–218. doi: 10.1016/j.cld.2020.01.012
26. Koul R., Maiwall R., Ramalingam A., Kumar S., Dhamija R.M., Pamecha V., Sarin S.K. Role of EEG in Predicting Outcome of Hepatic Encephalopathy Patients. Neurodiagn J. 2020;60(4):272–288. doi: 10.1080/21646821.2020.1824959
27. Montagnese S., Balistreri E., Schiff S., De Rui M., Angeli P., Zanus G., Cillo U., Bombonato G., Bolognesi M., Sacerdoti D., Gatta A., Merkel C., Amodio P. Covert hepatic encephalopathy: agreement and predictive validity of different indices. World J Gastroenterol. 2014;20(42):15756–62. doi: 10.3748/wjg.v20.i42.15756
28. Rose C., Butterworth R.F., Zayed J., Normandin L., Todd K., Michalak A., Spahr L., Huet P.M., Pomier-Layrargues G. Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunction. Gastroenterology. 1999;117(3):640–4. doi: 10.1016/s0016-5085(99)70457-9
29. Olanow C.W. Manganese-induced parkinsonism and Parkinson’s disease. Ann N Y Acad Sci. 2004;1012:209–23. doi: 10.1196/annals.1306.018
30. Rovira A., Alonso J., Córdoba J. MR imaging findings in hepatic encephalopathy. AJNR Am J Neuroradiol. 2008;29(9):1612–21. doi: 10.3174/ajnr.A1139
31. Cheong I., Marjańska M., Deelchand D.K., Eberly L.E., Walk D., Öz G. Ultra-High Field Proton MR Spectroscopy in Early-Stage Amyotrophic Lateral Sclerosis. Neurochem Res. 2017;42(6):1833–1844. doi: 10.1007/s11064-017-2248-2
32. Lim C.G., Hahm M.H., Lee H.J. Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review. J Yeungnam Med Sci. 2023;40(2):136–145. doi: 10.12701/jyms.2022.00689
33. Chavarria L., Cordoba J. Magnetic resonance imaging and spectroscopy in hepatic encephalopathy. J Clin Exp Hepatol. 2015;5(Suppl 1):S69–74. doi: 10.1016/j.jceh.2013.10.001
34. Zeng G., Penninkilampi R., Chaganti J., Montagnese S., Brew B.J., Danta M. Meta-analysis of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy. Neurology. 2020;94(11):e1147–e1156. doi: 10.1212/WNL.0000000000008899
35. Nikonov E.L., Aksenov V.A. Hepatic encephalopathy. Russian Journal of Evidence-Based Gastroenterology. 2017;6(4):25–31. (In Russ.). https://doi.org/10.17116/dokgastro20176425-31
36. Ivashkin V.T., Maevskaya M.V., Zharkova M.S., Zhigalova S.B., Kitsenko E.A., Manukyan G.V., Trukhmanov A.S., Maev I.V., Tikhonov I.N., Deeva T.A. Clinical Recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on Diagnosis and Treatment of Liver Fibrosis, Cirrhosis and Their Complications. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021;31(6):56–102. (In Russ.). https://doi.org/10.22416/1382-4376-2021-31-6-56-102
Review
For citations:
Kuznetsova P.I., Raskurazhev A.A., Morozova S.N., Lovchev I.M., Novruzbekov M.S., Tanashyan M.M. Minimal hepatic encephalopathy: clinical, neurophysiological, neuroimaging markers. Russian neurological journal. 2023;28(5):21-27. (In Russ.) https://doi.org/10.30629/2658-7947-2023-28-5-21-27
Views:
467
Email this article 