Skip to main content
Log in

Characteristics of Minimal Hepatic Encephalopathy

  • Published:
Metabolic Brain Disease Aims and scope Submit manuscript

Abstract

The term minimal hepatic encephalopathy refers to the subtle changes in cognitive function, electrophysiological parameters, cerebral neurochemical/neurotransmitter homeostasis, cerebral blood flow, metabolism, and fluid homeostasis that can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy. Use of this term emphasizes the fact that the entity of hepatic encephalopathy is a single syndrome with quantitatively distinct features relating to severity. The absence of clinical evidence of hepatic encephalopathy is key to the diagnosis and can only be determined by a detailed assessment of the patients' history and a comprehensive neurological assessment of consciousness, cognitive, and motor function. The neuropsychological features of minimal hepatic encephalopathy point to a disorder of executive functioning, particularly selective attention and psychomotor speed, but other abnormalities may be observed. Alterations in electrophysiological variables have been described; endogenous evoked potentials are, in principle, more likely to reflect the presence of minimal hepatic encephalopathy, since they reflect cognitive phenomena rather than mere stimulus conduction but the specificity of the changes observed is unclear at present. Changes have also been described in the execution of diadochokinetic movements and in the capacity to discriminate flickering light, both of which may have diagnostic potential. The changes observed in cerebral blood flow and metabolism in SPET, PET, and 1H and 31P MRS studies reflect the pathogenic process that underlies the condition rather than providing diagnostic information. Similarly, the morphological brain abnormalities identified in this population, including mild brain oedema, hyperintensity of the globus pallidus and other subcortical nuclei observed in cerebral MR studies, and the central and cortical atrophy observed in neural imaging studies, are unlikely to have diagnostic utility. The presence of minimal hepatic encephalopathy is not without clinical consequence; it has a detrimental effect on health-related quality of life, the ability to perform complex tasks such as driving, and on outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Amodio, P., Del Piccolo, F., Marchetti, P., Angeli, P., Iemmolo, R., Caregaro, L., Merkel, C., Gerunda, G., and Gatta, A. (1999a). Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29:1662–1667.

    PubMed  Google Scholar 

  • Amodio, P., Del Piccolo, F., Pettenò, E., Mapelli, D., Angeli, P., Iemmolo, R., Muraca, M., Musto, C., Gerunda, G., Rizzo, C., Merkel, C., and Gatta, A. (2001). Prevalence and prognostic value of quantified electroencephalo-gram (EEG) alterations in cirrhotic patients. J. Hepatol. 35:37–45.

    PubMed  Google Scholar 

  • Amodio, P., Marchetti, P., Del Piccolo, F., Beghi, A., Comacchio, F., Carraro, P., Campo, G., Baruzzo, L., Marchiori, C., and Gatta, A. (1997). The effect of flumazenil on subclinical psychometric or neurophysio-logical alterations in cirrhotic patients: A double-blind placebo-controlled study. Clin. Physiol. 17:533–539.

    Article  PubMed  Google Scholar 

  • Amodio, P., Marchetti, P., Del Piccolo, F., Campo, G., Rizzo, C., Iemmolo, R.M., Gerunda, G., Caregaro, L., Merkel, C., and Gatta, A. (1998). Visual attention in cirrhotic patients: A study on covert visual attention orienting. Hepatology 27:1517–1523.

    PubMed  Google Scholar 

  • Amodio, P., Marchetti, P., Del Piccolo, F., de Tourtchaninoff, M., Varghese, P., Zuliani, C., Campo, G., Gatta, A., and Guérit, J.M. (1999b). Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin. Neuro-physiol. 110:1334–1344.

    Google Scholar 

  • Amodio, P., Marchetti, P., Del Piccolo, F., Sartori, G., Prior, M., Merkel, C., and Gatta, A. (1995). Visual attention orienting in liver cirrhosis without overt hepatic encephalopathy. Metab. Brain Dis. 10:335–345.

    PubMed  Google Scholar 

  • Amodio, P., Pellegrini, A., Amistà, P., Luise, S., Del Piccolo, F., Mapelli, D., Montagnese, S., Musto, C., Valenti, P., and Gatta, A. (2003). Neuropsychological–neurophysiological alterations and brain atrophy in cirrhotic patients. Metab. Brain Dis. 18:63–78.

    PubMed  Google Scholar 

  • Amodio, P., Quero, J.C., Del Piccolo, F., Gatta, A., and Schalm, S.W. (1996). Diagnostic tools for the detection of subclinical hepatic encephalopathy: Comparison of standard and computerized psychometric tests with spectral-EEG. Metab. Brain Dis. 11:315–327.

    PubMed  Google Scholar 

  • Amodio, P., Wenin, H., Del Piccolo, F., Mapelli, D., Montagnese, S., Pellegrini, A., Musto, C., Gatta, A., and Umiltà, C. (2002). Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Ageing: Clin. Exp. Res. 14:117–131.

    Google Scholar 

  • Begleiter, H., Porjesz, B., and Chou, C.L. (1981). Auditory brainstem potentials in chronic alcoholics. Science 211:1064–1066.

    PubMed  Google Scholar 

  • Bernthal, P., Hays, A., Tarter, R.E., Van Thiel, D., Lecky, J., and Hegedus, A. (1987). Cerebral CT scan abnormal-ities in cholestatic and hepatocellular disease and their relationship to neuropsychologic test performance. Hepatology 7:107–114.

    PubMed  Google Scholar 

  • Blei, A.T., and Córdoba, J. (1996). Subclinical encephalopathy. Dig. Dis. Sci. 14(Suppl. 1):2–11.

    Google Scholar 

  • Blei, A.T., and Córdoba, J. (2001). Hepatic encephalopathy. Am. J. Gastroenterol. 96:1968–1976.

    PubMed  Google Scholar 

  • Burra, P., Dam, M., Chierichetti, F., Tedeschi, U., Senzolo, M., Sale, E., Cagnin, A., Ori, C., Naccarato, R., Ferlin, G., and Pizzolato, G. (1999). 18F-fluorodeoxyglucose positron emission tomography study of brain metabolism in cirrhosis: Effect of liver transplantation. Transplant. Proc. 31:418–420.

    PubMed  Google Scholar 

  • Burra, P., Pizzolato, G., Orlando, F., Rossato, A., Chierichetti, F., Tedeschi, U., Rossaro, L., Salvagnini, N., Ermani, M., and Dam, M. (1994). Single-photon emission computed tomography with 99mTC-hexamethyl-propyleneamineoxide in cirrhotic patients before and after liver transplantation. Transplant. Proc. 26:3677–3678.

    PubMed  Google Scholar 

  • Butterworth, R.F. (1996). The neurobiology of hepatic encephalopathy. Semin. Liver Dis. 16:235–244.

    PubMed  Google Scholar 

  • Cadranel, J.F., Lebiez, E., Di Martino, V., Bernard, B., El Koury, S., Tourbah, A., Pidoux, B., Valla, D., and Opolon, P. (2001). Focal neurological signs in hepatic encephalopathy in cirrhotic patients: An underestimated entity? Am. J. Gastroenterol. 96:515–518.

    PubMed  Google Scholar 

  • Carpenter, P.A., Just, M.A., and Reichle, E.D. (2000). Working memory and executive function: Evidence from neuroimaging. Curr. Opin. Neurobiol. 10:195–199.

    PubMed  Google Scholar 

  • Chu, N.S., Yang, S.S., and Liaw, Y.F. (1997). Evoked potentials in liver diseases. J. Gastroenterol. Hepatol. 12:S288–S293.

    PubMed  Google Scholar 

  • Churchill's Medical Dictionary (1994). Churchill Livingstone, New York.

  • Conn, H.O., Leevy, C.M., Vlahcevic, Z.R., Rodgers, J.B., Maddrey, W.C., Seeff, L., and Levy, L.L. (1977). Comparison of lactulose and neomycin in the treatment of chronic portal–systemic encephalopathy. A double blind controlled trial. Gastroenterology 72:573–583.

    PubMed  Google Scholar 

  • Córdoba, J., Sanpedro, F., Alonso, J., and Rovira, A. (2002). 1H magnetic resonance in the study of hepatic encephalopathy in humans. Metab. Brain Dis. 17:415–429.

    PubMed  Google Scholar 

  • Dam, M., Burra, P., Tedeschi, U., Cagnin, A., Chierichetti, F., Ermani, M., Ferlin, G., Naccarato, R., and Pizzolato, G. (1998). Regional cerebral blood flow changes in patients with cirrhosis assessed with 99mTc-HM-PAO single-photon emission computed tomography: Effect of liver transplantation. J. Hepatol. 29:78–84.

    PubMed  Google Scholar 

  • Das, A., Dhiman, R.K., Saraswat, V.A., Verma, M., and Naik, S.R. (2001). Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J. Gastroenterol. Hepatol. 16:531–535.

    PubMed  Google Scholar 

  • Davidson, E.A., and Summerskill, W.H.J. (1956). Psychiatric aspects of liver disease. Postgrad. Med. J. 32:487–494.

    PubMed  Google Scholar 

  • Desmedt, J.E. (1980). P300 in serial tasks: An essential post-decision closure mechanism. Prog. Brain Res. 54:682–686.

    PubMed  Google Scholar 

  • Donchin, E., and Isreal, J.B. (1980). Event-related potentials and psychological theory. Prog. Brain Res. 54:697–715.

    PubMed  Google Scholar 

  • Douglass, A., Al Mardini, H., and Record, C. (2001). Amino acid challenge in patients with cirrhosis: A model for the assessment of treatments for hepatic encephalopathy. J. Hepatol. 34:658–664.

    PubMed  Google Scholar 

  • Eckstein, A.K., Reichenbach, A., Jacobi, P., Weber, P., Gregor, M., and Zrenner, E. (1997). Hepatic retinopathia. Changes in retinal function. Visi on Res. 37:1699–1706.

    Google Scholar 

  • Elsass, P., Christensen, S.E., Mortensen, E.L., and Vilstrup, H. (1985). Discrimination between organic and hepatic encephalopathy by means of continuous reaction times. Liver 5:29–34.

    PubMed  Google Scholar 

  • Elsass, P., Lund, Y., and Ranek, L. (1978). Encephalopathy in patients with cirrhosis of the liver. A neuropsycho-logical study. Scand. J. Gastroenterol. 13:241–247.

    PubMed  Google Scholar 

  • Epstein, C.M., Riether, A.M., Henderson, R.M., and Cotsonis, G.A. (1992). EEG in liver transplantation: Visual and computerized analysis. Electroencephalogr. Clin. Neurophysiol. 83:367–371.

    PubMed  Google Scholar 

  • Ferenci, P., Lockwood, A., Mullen, K., Tarter, R., Weissenborn, K., and Blei, A.T. (2002). Hepatic encephalopathy– definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721.

    PubMed  Google Scholar 

  • Folstein, M.F., Folstein, S.E., and McHugh, P.R. (1975). "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12:189–198.

    PubMed  Google Scholar 

  • Forton, D.M., Taylor-Robinson, S.D., and Thomas, H.C. (2003). Cerebral dysfunction in chronic hepatitis C infection. J. Viral Hepat. 10:81–86.

    PubMed  Google Scholar 

  • Forton, D.M., Thomas, H.C., Murphy, C.A., Allsop, J.M., Foster, G.R., Main, J., Wesnes, K.A., and Taylor-Robinson, S.D. (2002). Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology 35:433–439.

    PubMed  Google Scholar 

  • Gilberstadt, S.J., Gilberstadt, H., Zieve, L., Buegel, B., Collier, R.O., Jr., and McClain, C.J. (1980). Psychomo-tor performance defects in cirrhotic patients without overt encephalopathy. Arch. Intern. Med. 140:519–521.

    PubMed  Google Scholar 

  • Groeneweg, M., Moerland, W., Quero, J.C., Hop, W.C., Krabbe, P.F., and Schalm, S.W. (2000). Screening of subclinical hepatic encephalopathy. J. Hepatol. 32:748–753.

    PubMed  Google Scholar 

  • Groeneweg, M., Quero, J.C., De Bruijn, I., Hartmann, I.J., Essink-bot, M.L., Hop, W.C., and Schalm, S.W. (1998). Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28:45–49.

    PubMed  Google Scholar 

  • Guérit, J.M., Amodio, P., Hafner, H., Litscher, G., and Van Huffelen, A.C. (2000). Neuromonitoring in the operating room and intensive care unit: An update. Clin. Neurophysiol. 5 3(Suppl.):61–71.

    Google Scholar 

  • Hartmann, I.J., Groeneweg, M., Quero, J.C., Beijeman, S.J., de Man, R.A., Hop, W.C., and Schalm, S.W. (2000). The prognostic significance of subclinical hepatic encephalopathy. Am. J. Gastroenterol. 95:2029–2034.

    PubMed  Google Scholar 

  • Häussinger, D., Kircheis, G., Fischer, R., Schliess, F., and von Dahl, S. (2000). Hepatic encephalopathy in chronic liver disease: A clinical manifestation of astrocyte swelling and low-grade cerebral edema? J. Hepatol. 32:1035–1038.

    PubMed  Google Scholar 

  • Hilsabeck, R.C., Perry, W., and Hassanein, T.I. (2002). Neuropsychological impairment in patients with chronic hepatitis C. Hepatology 35:440–446.

    PubMed  Google Scholar 

  • Joebges, E.M., Heidemann, M., Schimke, N., Hecker, H., Ennen, J.C., and Weissenborn, K. (2003). Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation. J. Hepatol. 38:273–280.

    PubMed  Google Scholar 

  • Jover, R., Compañy, L., Gutiérrez, A., Zapater, P., Pérez-Serra, J., Girona, E., Aparicio, J.R., and Pérez-Mateo, M. (2003). Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. Am. J. Gastroenterol. 98:1599–1604.

    PubMed  Google Scholar 

  • Kircheis, G., Wettstein, M., Timmermann, L., Schnitzler, A., and Häussinger, D. (2002). Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology 35:357–366.

    PubMed  Google Scholar 

  • Kono, I., Ueda, Y., Nakajima, K., Araki, K., Kagawa, K., and Kashima, K. (1994). Subcortical impairment in subclinical hepatic encephalopathy. J. Neurol. Sci. 126:162–167.

    PubMed  Google Scholar 

  • Kramer, L., Bauer, E., Funk, G., Hofer, H., Jessner, W., Steindl-Munda, P., Wrba, F., Madl, C., Gangl, A., and Ferenci, P. (2002a). Subclinical impairment of brain function in chronic hepatitis C infection. J. Hepatol. 37:349–354.

    PubMed  Google Scholar 

  • Kramer, L., Bauer, E., Gendo, A., Funk, G., Madl, C., Pidlich, J., and Gangl, A. (2002b). Neurophysiological evidence of cognitive impairment in patients without hepatic encephalopathy after transjugular intrahepatic portosystemic shunts. Am. J. Gastroenterol. 97:162–166.

    PubMed  Google Scholar 

  • Krieger, S., Jauss, M., Jansen, O., Theilmann, L., Geissler, M., and Krieger, D. (1996). Neuropsychiatric profile and hyperintense globus pallidus on T1-weighted magnetic resonance images in liver cirrhosis. Gastroenterology 111:147–155.

    PubMed  Google Scholar 

  • Kügler, C.F., Lotterer, E., Petter, J., Wensing, G., Taghavy, A., Hahn, E.G., and Fleig, W.E. (1992). Visual event-related P300 potentials in early portosystemic encephalopathy. Gastroenterology 103:302–310.

    PubMed  Google Scholar 

  • Kügler, C.F., Petter, J., Taghavy, A., Lotterer, E., Wensing, G., Hahn, E.G., and Fleig, W.E. (1994). Dynamics of cognitive brain dysfunction in patients with cirrhotic liver disease: An event-related P300 potential perspective. Electroencephalogr. Clin. Neurophysiol. 91:33–41.

    PubMed  Google Scholar 

  • Kullmann, F., Hollerbach, S., Holstege, A., and Schölmerich, J. (1995). Subclinical hepatic encephalopathy: The diagnostic value of evoked potentials. J. Hepatol. 22:101–110.

    Google Scholar 

  • Levy, L.J., Bolton, R.P., and Losowsky, M.S. (1987). The use of the visual evoked potential (VEP) in delineating a state of subclinical encephalopathy. A comparison with the number connection test (NCT). J. Hepatol. 5:211–217.

    PubMed  Google Scholar 

  • Lockwood, A.H. (2000). "What's in a name?" Improving the care of cirrhotics. J. Hepatol. 32:859–861.

    PubMed  Google Scholar 

  • Lockwood, A.H., Murphy, B.W., Donnelly, K.Z., Mahl, T.C., and Perini, S. (1993). Positron-emission tomo-graphic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy.Hepatology 18:1061–1068.

    Article  PubMed  Google Scholar 

  • Lockwood, A.H., Weissenborn, K., Bokemeyer, M., Tietge, U., and Burchert, W. (2002). Correlations between cerebral glucose metabolism and neuropsychological test performance in nonalcoholic cirrhotics. Metab. Brain Dis. 17:29–40.

    PubMed  Google Scholar 

  • Marchesini, G., Bianchi, G., Amodio, P., Salerno, F., Merli, M., Panella, C., Loguercio, C., Apolone, G., Niero, M., and Abbiati, R. (2001). Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 120:170–178.

    PubMed  Google Scholar 

  • McCrea, M., Córdoba, J., Vessey, G., Blei, A.T., and Randolph, C. (1996). Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch. Neurol. 53:758–763.

    PubMed  Google Scholar 

  • Mehndiratta, M.M., Sood, G.K., Sarin, S.K., and Gupta, M. (1990). Comparative evaluation of visual, somatosen-sory, and auditory evoked potentials in the detection of subclinical hepatic encephalopathy in patients with nonalcoholic cirrhosis. Am. J. Gastroenterol. 85:799–803.

    PubMed  Google Scholar 

  • Messenheimer, J.A., Greenwood, R.S., Tennison, M.B., Brickley, J.J., and Ball, C.J. (1984). Reversible visual evoked potential abnormalities in vitamin E deficiency. Ann. Neurol. 15:499–501.

    PubMed  Google Scholar 

  • Moore, J.W., Dunk, A.A., Crawford, J.R., Deans, H., Besson, J.A., De Lacey, G., Sinclair, T.S., Mowat, N.A., and Brunt, P.W. (1989). Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis. A controlled study. J. Hepatol. 9:319–325.

    PubMed  Google Scholar 

  • Niedermeyer, E. (1999). Metabolic central nervous system disorders. In (E. Niedermeyer and F. Lopes Da Silva, eds.), Electroencephalography. Basic Principles, Clinical Applications, and Related Fields, 4th edn., Williams & Wilkins, Baltimore, pp. 416–431.

    Google Scholar 

  • Norenberg, M.D., and Bruce-Gregorios, J. (1997). Nervous system manifestation of systemic disease. In (R.L. Davies and D.M. Robertson, eds.), Textbook of Neuropathology, Williams & Wilkins, Baltimore, pp. 547–625.

    Google Scholar 

  • O'Carroll, R.E., Hayes, P.C., Ebmeier, K.P., Dougall, N., Murray, C., Best, J.J., Bouchier, I.A., and Goodwin, G.M. (1991). Regional cerebral blood flow and cognitive function in patients with chronic liver disease. Lancet 337:1250–1253.

    Article  PubMed  Google Scholar 

  • Parsons-Smith, B.G., Summerskill, W.H.J., Dawson, A.M., and Sherlock, S. (1957). The electroencephalograph in liver disease. Lancet 2:867–871.

    Google Scholar 

  • Porjesz, B., and Begleiter, H. (1981). Human evoked brain potentials and alcohol. Alcohol: Clin. Exp. Res. 5:304–317.

    Google Scholar 

  • Posner, M.I., and Petersen, S.E. (1990). The attention system of the human brain. Annu. Rev. Neurosci. 13:25–42.

    PubMed  Google Scholar 

  • Pritchard, W.S. (1981). Psychophysiology of P300. Psychol. Bull. 89:506–540.

    PubMed  Google Scholar 

  • Pujol, A., Pujol, J., Graus, F., Rimola, A., Peri, J., Mercader, J.M., Garcia-Pagan, J.C., Bosch, J., Rodés, J., and Tolosa, E. (1993). Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology 43:65–69.

    PubMed  Google Scholar 

  • Quero, J.C., Hartmann, I.J., Meulstee, J., Hop, W.C., and Schalm, S.W. (1996). The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroen-cephalogram analysis. Hepatology 24:556–560.

    Article  PubMed  Google Scholar 

  • Quero, J.C., and Schalm, S.W. (1996). Subclinical hepatic encephalopathy. Semin. Liver Dis. 16:321–328.

    PubMed  Google Scholar 

  • Rehnström, S., Simert, G., Hansson, J.A., Johnson, G., and Vang, J. (1977). Chronic hepatic encephalopathy. A psychometrical study. Scand. J. Gastroenterol. 12:305–311.

    PubMed  Google Scholar 

  • Reitan, R.M. (1955). The relation of the trail making test to organic brain damage. J. Consult. Psychol. 19:393–394.

    PubMed  Google Scholar 

  • Rikkers, L., Jenko, P., Rudman, D., and Freides, D. (1978). Subclinical hepatic encephalopathy: Detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462–469.

    PubMed  Google Scholar 

  • Ross, B.D., Danielsen, E.R., and Bluml, S. (1996). Proton magnetic resonance spectroscopy: The new gold standard for diagnosis of clinical and subclinical hepatic encephalopathy? Dig. Dis. Sci. 14(Suppl. 1):30–39.

    Google Scholar 

  • Ross, B.D., Jacobson, S., Villamil, F., Korula, J., Kreis, R., Ernst, T., Shonk, T., and Moats, R.A. (1994). Subclinical hepatic encephalopathy: Proton MR spectroscopic abnormalities. Radiology 193:457–463.

    PubMed  Google Scholar 

  • Sagalés, T., Gimeno, V., de la Calzada, M.D., Casellas, F., Dolors Mascià, M., and Villar Soriano, M. (1990). Brain mapping analysis in patients with hepatic encephalopathy. Brain Topogr. 2:221–228.

    PubMed  Google Scholar 

  • Sandford, N.L., and Saul, R.E. (1988). Assessment of hepatic encephalopathy with visual evoked potentials compared with conventional methods. Hepatology 8:1094–1098.

    PubMed  Google Scholar 

  • Saxena, N., Bhatia, M., Joshi, Y.K., Garg, P.K., Dwivedi, S.N., and Tandon, R.K. (2002). Electrophysiological and neuropsychological tests for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy. Liver 22:190–197.

    PubMed  Google Scholar 

  • Saxena, N., Bhatia, M., Joshi, Y.K., Garg, P.K., and Tandon, R.K. (2001). Auditory P300 event-related potentials and number connection test for evaluation of subclinical hepatic encephalopathy in patients with cirrhosis of the liver: A follow-up study. J. Gastroenterol. Hepatol. 16:322–327.

    PubMed  Google Scholar 

  • Schomerus, H., and Hamster, W. (1998). Neuropsychological aspects of portal–systemic encephalopathy. Metab. Brain Dis. 13:361–377.

    PubMed  Google Scholar 

  • Schomerus, H., and Hamster, W. (2001). Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab. Brain Dis. 16:37–41.

    PubMed  Google Scholar 

  • Schomerus, H., Hamster, W., Blunck, H., Reinhard, U., Mayer, K., and Dolle, W. (1981). Latent portasystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive. Dig. Dis. Sci. 26:622–630.

    PubMed  Google Scholar 

  • Srivastava, A., Mehta, R., Rothke, S.P., Rademaker, A.W., and Blei, A.T. (1994). Fitness to drive in patients with cirrhosis and portal–systemic shunting: A pilot study evaluating driving performance. J. Hepatol. 21:1023–1028.

    PubMed  Google Scholar 

  • Suzuki, C., Ozaki, I., Tanosaki, M., Suda, T., Baba, M., and Matsunaga, M. (2000). Peripheral and central conduction abnormalities in diabetes mellitus. Neurology 54:1932–1937.

    PubMed  Google Scholar 

  • Tarter, R.E., Arria, A.M., Carra, J., and Van Thiel, D.H. (1987a). Memory impairments concomitant with nonalcoholic cirrhosis. Int. J. Neurosci. 32:853–859.

    PubMed  Google Scholar 

  • Tarter, R.E., Carra, J., Switala, J., and Van Thiel, D.H. (1987b). Sequential concept formation capacity in subclinical (latent) portal–systemic encephalopathy. Int. J. Neurosci. 32:891–894.

    PubMed  Google Scholar 

  • Tarter, R.E., Hegedus, A.M., Van Thiel, D.H., Schade, R.R., Gavaler, J.S., and Starzl, T.E. (1984). Non-alcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 86:1421–1427.

    PubMed  Google Scholar 

  • Taylor-Robinson, S.D., Sargentoni, J., Mallalieu, R.J., Bell, J.D., Bryant, D.J., Coutts, G.A., and Morgan, M.Y. (1994). Cerebral phosphorus-31 magnetic resonance spectroscopy in patients with chronic hepatic encephalopathy. Hepatology 20:1173–1178.

    PubMed  Google Scholar 

  • Teasdale, G., and Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84.

    PubMed  Google Scholar 

  • Thuluvath, P.J., Edwin, D., Yue, N.C., deVilliers, C., Hochman, S., and Klein, A. (1995). Increased signals seen in globus pallidus in T1-weighted magnetic resonance imaging in cirrhotics are not suggestive of chronic hepatic encephalopathy. Hepatology 21:440–442.

    PubMed  Google Scholar 

  • Trzepacz, P.T., Tarter, R.E., Shah, A., Tringali, R., Faett, D.G., and Van Thiel, D.H. (1994). SPECT scan and cognitive findings in subclinical hepatic encephalopathy. J. Neuropsychiatry Clin. Neurosci. 6:170–175.

    PubMed  Google Scholar 

  • Van der Rijt, C.C., and Schalm, S.W. (1992). Quantitative EEG analysis and evoked potentials to measure (latent) hepatic encephalopathy. J. Hepatol. 14:141–142.

    PubMed  Google Scholar 

  • Van der Rijt, C.C., Schalm, S.W., De Groot, G.H., and de Vlieger, M. (1984). Objective measurement of hepatic encephalopathy by means of automated EEG analysis. Electroencephalogr. Clin. Neurophysiol. 57:423–426.

    PubMed  Google Scholar 

  • Victor, M., Adams, R.D., and Cole, M. (1965). The acquired (non Wilsonian) type of chronic hepatocerebral degeneration. Medicine 44:345–396.

    PubMed  Google Scholar 

  • Virtaniemi, J., Kuusisto, J., Karjalainen, L., Karjalainen, S., and Laakso, M. (1995). Improvement of metabolic control does not normalize auditory brainstem latencies in subjects with insulin-dependent diabetes mellitus. Am. J. Otolaryngol. 16:172–176.

    PubMed  Google Scholar 

  • Weissenborn, K. (1998). Diagnosis of encephalopathy. Digestion 5 9(Suppl. 2):22–24.

    PubMed  Google Scholar 

  • Weissenborn, K., Ennen, J.C., Schomerus, H., Rückert, N., and Hecker, H. (2001). Neuopsychological character-ization of hepatic encephalopathy. J. Hepatol. 34:768–773.

    PubMed  Google Scholar 

  • Weissenborn, K., Heidenreich, S., Giewekemeyer, K., Rückert, N., and Hecker, H. (2003). Memory function in early hepatic encephalopathy. J. Hepatol. 39:320–325.

    PubMed  Google Scholar 

  • Weissenborn, K., Rückert, N., Hecker, H., and Manns, M.P. (1998). The number connection tests A and B: Interindividual variability and use for the assessment of early hepatic encephalopathy. J. Hepatol. 28:646–653.

    PubMed  Google Scholar 

  • Weissenborn, K., Scholz, M., Hinrichs, H., Wiltfang, J., Schmidt, F.W., and Kunkel, H. (1990). Neurophysiological assessment of early hepatic encephalopathy. Electroencephalogr. Clin. Neurophysiol. 75:289–295.

    PubMed  Google Scholar 

  • Yang, S.S., Wu, C.H., Chiang, T.R., and Chen, D.S. (1998). Somatosensory evoked potentials in subclinical portosystemic encephalopathy: A comparison with psychometric tests. Hepatology 27:357–361.

    PubMed  Google Scholar 

  • Yen, C.L., and Liaw, Y.F. (1990). Somatosensory evoked potentials and number connection test in the detection of subclinical hepatic encephalopathy. Hepatogastroenterology 37:332–334.

    PubMed  Google Scholar 

  • Zeegen, R., Drinkwater, J.E., and Dawson, A.M. (1970). Method for measuring cerebral dysfunction in patients with liver disease. BMJ 2:633–636.

    PubMed  Google Scholar 

  • Zeneroli, M.L., Cioni, G., Vezzelli, C., Grandi, S., Crisi, G., Luzietti, R., and Ventura, E. (1987). Prevalence of brain atrophy in liver cirrhosis patients with chronic persistent encephalopathy. Evaluation by computed tomography. J. Hepatol. 4:283–292.

    PubMed  Google Scholar 

  • Zeneroli, M.L., Pinelli, G., Gollini, G., Penne, A., Messori, E., Zani, G., and Ventura, E. (1984). Visual evoked potential: A diagnostic tool for the assessment of hepatic encephalopathy. Gut 25:291–299.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Amodio, P., Montagnese, S., Gatta, A. et al. Characteristics of Minimal Hepatic Encephalopathy. Metab Brain Dis 19, 253–267 (2004). https://doi.org/10.1023/B:MEBR.0000043975.01841.de

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:MEBR.0000043975.01841.de

Navigation