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NEUROLOGIC COMPLICATIONS OF LIVER DISEASE

Neurologic complications can occur in patients with acute or chronic liver disease, ranging from vague symptoms to severe conditions like coma. This article discusses the clinical features of hepatic encephalopathy, the course of hepatic encephalopathy stages, and other clinical features such as spastic paraplegia and parkinsonian syndromes. It also covers acute liver failure symptoms, pathophysiology related to ammonia toxicity, and therapy options for managing neurologic complications.

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NEUROLOGIC COMPLICATIONS OF LIVER DISEASE

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  1. NEUROLOGICCOMPLICATIONS OF LIVER DISEASE Dr. ANAS JOUHAR

  2. NEUROLOGIC COMPLICATIONS can be observed in patients with either acute or chronic liver • Range from vogues symptoms ( fatigue ) to sever (coma )

  3. Clinical features of hepatic Encephalopathy ( Cirrhosis ) • Most characteristic symptoms extrapyramidal symptoms • Neurological examination may disclose some hepatic failure before it disclose clinically.

  4. Clinical course of HE • Minimal HE : Slight attention deficits • HE I : Psychomotor slowing • HE II : Disorientation, bizarre, lethargy • HE III : Somnolence – stupor • HE IV : Coma

  5. Other clinical feature of HE • Rapid progress spastic paraplegia (hepatic mylopathy ) • Progress parkinsonian syndromes (hepatolenticular degeneration ) • Both of them due to portosystemic shunt

  6. Acute Liver Failure • Symptoms progress very fast • Brain edema and seizure common in ALF • Seizure seen in 45% of ALF • Seizure due to plasma amonia levels > 120 mico mol/L

  7. PATHOPHYSIOLOGY • Ammonia has been considered as main toxin to development of HE • Recent hypotheses focus on ammonia induced astrocyte swelling

  8. THERAPY • Aimed at the reduction of ammonia production and absorption in gut • Nonabsorbable disaccharides and antibiotics • Ornithineaspartate is used to support ammonia metabolism in muscle

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