Skip to main content
SpringerLink
Log in

Quantification of Changes in Electroencephalographic Power Spectra in a Patient with Budd-Chiari-Syndrome after Implantation of a Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS)

  • Published:
Metabolic Brain Disease Aims and scope Submit manuscript

Abstract

We examined a 41-year-old female with a subacute Budd-Chiari Syndrome (BCS) before and after implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS) by means of digital electroencephalography (EEG). After TIPSS implantation hepatic decompression had been achieved and the liver function as well as the clinical status improved daily. Simultaneously, the digital EEG showed a decrease in the power of the theta band and an increase in the physiological alpha frequency band. The theta/alpha ratio decreased after TIPSS, despite an elevated arterial ammonia level. The patient had a well-preserved liver parenchyma before the occurrence of the BCS. After portal decompression by TIPSS, the liver function normalized and the liver resumed efficient synthesis and parts of its detoxification task. This regeneration capacity was documented by a rise in cholinesterase after TIPSS. After temporary substitution of albumin the serum albumin concentration returned to normal. Thus, some neurotoxic substances with high albumin-binding capacity may not be absorbed by the central nervous system (CNS). Furthermore, it appears likely that the length of time the brain is exposed to neurotoxic substances plays a role in the clinical and electroencephalographic changes. Compared to the conventional EEG the theta/alpha ratio reflected better metabolically conditioned electroencephalographic changes after TIPSS.

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

Access this article

Log in via an institution

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

Abbreviations

BCS:

Budd-Chiari Syndrome

PSE:

portal-systemic encephalopathy

HE:

hepatic encephalopathy

sPSE:

subclinical portal-systemic encephalopathy

TIPSS:

transjugular intrahepatic portosystemic stent shunt

EEG:

electroencephalography

MDF:

mean dominant frequency

Hz:

Hertz

PC:

personal computer

CNS:

central nervous system

References

  • Bahn, E., Nolte, W., Kurth, C., Ramadori, G., Ruther, E., and Wiltfang, J. (2002). Quantification of the electroencephalographic theta/alpha ratio for the assessment of portal-systemic encephalopathy following implantation of transjugular intrahepatic portosystemic stent shunt (TIPSS). Metab. Brain Dis. 17:19–28.

    Article  PubMed  Google Scholar 

  • Blum, U., Rossle, M., Haag, K., Ochs, A., Blum, H.E., Hauenstein, K.H., Astinet, F., and Langer, M. (1995). Budd-Chiari Syndrome–-Technical, hemodynamic, and clinical-results of treatment with transjugular intrahepatic portosystemic shunt. Radiology 197:805–811.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  • Dilawari, J.B., Bambery, P., Chawla, Y., Kaur, U., Bhusnurmath, S.R., Malhotra, H.S., Sood, G.K., Mitra, S.K., Khanna, S.K., and Walia, B.S. (1994). Hepatic outflow obstruction (Budd-Chiari syndrome). Experience with 177 patients and a review of the literature. Medicine (Baltimore) 73:21–36.

    CAS  Google Scholar 

  • Ganger, D.R., Klapman, J.B., McDonald, V., Matalon, T.A., Kaur, S., Rosenblate, H., Kane, R., Saker, M., and Jensen, D.M. (1999). Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis–-Review of indications and problems. Am. J. Gastroenterol. 94:603–608.

    CAS  PubMed  Google Scholar 

  • Jalan, R., Gooday, R., O’Carroll, R.E., Redhead, D.N., Elton, R.A., and Hayes, P.C. (1995). A prospective evaluation of changes in neuropsychological and liver function tests following transjugular intrahepatic portosystemic stent-shunt. J. Hepatol. 23:697–705.

    Article  CAS  PubMed  Google Scholar 

  • Mitchell, M.C., Boitnott, J.K., Kaufman, S., Cameron, J.L., and Maddrey, W.C. (1982). Budd-Chiari syndrome: Etiology, diagnosis and management. Medicine (Baltimore) 61:199–218.

    CAS  Google Scholar 

  • Nolte, W., Figulla, H.R., Ringe, B., Wiltfang, J., Munke, H., Hartmann, H., and Ramadori, G. (1997). Transjugular intrahepatic portosystemic stent shunt (TIPSS) in Budd-Chiari syndrome with portal vein thrombosis. Deutsche Medizinische Wochenschrift 122:116–121.

    CAS  PubMed  Google Scholar 

  • Ochs, A., Rossle, M., Haag, K., Hauenstein, K.H., Deibert, P., Siegerstetter, V., Huonker, M., Langer, M., and Blum, H.E. (1995). The Transjugular Intrahepatic Portosystemic Stent-Shunt Procedure for refractory ascites. N. Engl. J. Med. 332:1192–1197.

    Article  CAS  PubMed  Google Scholar 

  • Orloff, M.J., Daily, P.O., Orloff, S.L., Girard, B., and Orloff, M.S. (2000). A 27-year experience with surgical treatment of Budd-Chiari syndrome. Ann. Surg. 232:340–352.

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  • Perello, A., Garcia-Pagan, J.C., Gilabert, R., Suarez, Y., Moitinho, E., Cervantes, F., Reverter, J.C., Escorsell, A., Bosch, J., and Rodes, J. (2002). TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy. Hepatology 35:132–139.

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  • Van der Rijt, C.C., and Schalm, S.W. (1991). Spectral Analysis in Hepatic Encephalopathy, CRC, Boca Raton, FL.

    Google Scholar 

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

    Article  CAS  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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Georg-August-University Goettingen, Goettingen, Germany

    Erik Bahn

  2. Department of Psychiatry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany

    Jens Wiltfang

  3. Department of Internal Medicine, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany

    Wilhelm Nolte

  4. Department of Gastroenterology and Endocrinology, Department of Internal Medicine, Georg-August-University Goettingen, Goettingen, Germany

    Guiliano Ramadori

  5. Epilepsy Centre Kork, Kork, Germany

    Bernhard Steinhoff & Christoph Kurth

  6. Department of Psychiatry, Georg-August-University Goettingen, Goettingen, Germany

    Eckhardt Rüther

  7. Centre of Pathology, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany

    Erik Bahn

Authors
  1. Erik Bahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens Wiltfang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wilhelm Nolte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guiliano Ramadori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernhard Steinhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eckhardt Rüther
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christoph Kurth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik Bahn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bahn, E., Wiltfang, J., Nolte, W. et al. Quantification of Changes in Electroencephalographic Power Spectra in a Patient with Budd-Chiari-Syndrome after Implantation of a Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS). Metab Brain Dis 20, 1–6 (2005). https://doi.org/10.1007/s11011-005-2471-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11011-005-2471-4

Keywords

Search

Navigation