Brain edema: a valid endpoint for measuring hepatic encephalopathy?
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Hepatic encephalopathy (HE) is a major complication of liver failure/disease which frequently develops during the progression of end-stage liver disease. This metabolic neuropsychiatric syndrome involves a spectrum of symptoms, including cognition impairment, attention deficits and motor dysfunction which eventually can progress to coma and death. Pathologically, HE is characterized by swelling of the astrocytes which consequently leads to brain edema, a common feature found in patients with acute liver failure (ALF) as well as in cirrhotic patients suffering from HE. The pathogenic factors involved in the onset of astrocyte swelling and brain edema in HE are unresolved. However, the role of astrocyte swelling/brain edema in the development of HE remains ambiguous and therefore measuring brain edema as an endpoint to evaluate HE is questioned. The following review will determine the effect of astrocyte swelling and brain edema on neurological function, discuss the various possible techniques to measure brain edema and lastly to propose a number of neurobehavioral tests to evaluate HE.
KeywordsBrain edema Hepatic encephalopathy Astrocyte Magnetic resonance imaging Neurobehavior
Acute liver failure
Glial fibrillary acid protein
Regulatory volume decrease
Magnetic resonance imaging
Diffusion weighted imaging
Fast fluid-attenuated inversion recovery
Compliance with ethical standards
The authors have no conflicts to disclose.
- Amiry-Moghaddam M, Otsuka T, Hurn PD, Traystman RJ, Haug F-M, Froehner SC, Adams ME, Neely JD, Agre P, Ottersen OP, et al. (2003) An alpha-syntrophin-dependent pool of AQP4 in astroglial end-feet confers bidirectional water flow between blood and brain. Proc Natl Acad Sci U S A 100:2106–2111CrossRefPubMedPubMedCentralGoogle Scholar
- Amodio P, Campagna F, Olianas S, Iannizzi P, Mapelli D, Penzo M, Angeli P, Gatta A (2008) Detection of minimal hepatic encephalopathy: normalization and optimization of the psychometric hepatic encephalopathy score. A neuropsychological and quantified EEG study J Hepatol 49:346–353PubMedGoogle Scholar
- Córdoba J, Alonso J, Rovira A, Jacas C, Sanpedro F, Castells L, Vargas V, Margarit C, Kulisewsky J, Esteban R, et al. (2001) The development of low-grade cerebral edema in cirrhosis is supported by the evolution of (1)H-magnetic resonance abnormalities after liver transplantation. J Hepatol 35:598–604CrossRefPubMedGoogle Scholar
- Ennaceur A, Delacour J (1988) A new one-trial test for neurobiological studies of memory in rats. 1: behavioral data. Behav. Brain Res 31:47–59Google Scholar
- Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th world congresses of gastroenterology, Vienna, 1998. Hepatology 35:716–721CrossRefPubMedGoogle Scholar
- Iliff JJ, Wang M, Liao Y, Plogg BA, Peng W, Gundersen GA, Benveniste H, Vates GE, Deane R, Goldman SA, et al. (2012) A Paravascular Pathway Facilitates CSF Flow Through the Brain Parenchyma and the Clearance of Interstitial Solutes, Including Amyloid. Sci Transl Med 4:147ra111–ra147ra111CrossRefPubMedPubMedCentralGoogle Scholar
- Kimelberg HK (1987) Anisotonic media and glutamate-induced ion transport and volume responses in primary astrocyte cultures. J Physiol (Paris) 82:294–303Google Scholar
- Oria M, Chatauret N, Chavarria L, Romero-Giménez J, Palenzuela L, Pardo-Yules B, Arranz JA, Bodega G, Raguer N, Córdoba J (2010) Motor-evoked potentials in awake rats are a valid method of assessing hepatic encephalopathy and of studying its pathogenesis. Hepatology 52:2077–2085CrossRefPubMedGoogle Scholar
- Pellow S, Chopin P, File SE, Briley M (1985) Validation of open : closed arm entries in an elevated plus-maze as a measure of anxiety in the rat. J Neurosci 14:149–167Google Scholar
- Thrane AS, Takano T, Thrane VR, Wang F, Peng W, Ottersen OP, Nedergaard M, Nagelhus EA (2013) In vivo NADH fluorescence imaging indicates effect of aquaporin-4 deletion on oxygen microdistribution in cortical spreading depression. J Cereb Blood Flow Metab 33:996–999CrossRefPubMedPubMedCentralGoogle Scholar