Skip to main content

Hepatic Encephalopathy

  • Chapter
  • First Online:
Metabolic Encephalopathy
  • 1057 Accesses

Abstract

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with severe, acute and chronic liver failure. According to the recommendations of a working party (Ferenci et al., 2002) held at the 4th World Congress of Gastroenterology in Vienna in 1998, 3 types of HE should be differentiated, on principle:

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aggarwal, S., Kang, Y., DeWolf, A., Scott, V., Martin, M., Policare, R. 1993. Transcranial doppler monitoring of cerebral blood flow velocity during liver transplantation. Transplant Proc 25 (2): 1799–1800

    PubMed  CAS  Google Scholar 

  • Amodio, P., Gatta, A. 2005. Neurophysiological investigation of hepatic encephalopathy. Metabol Brain Dis 20 (4): 369–379

    Article  Google Scholar 

  • Amodio, P., Marchetti, P., Del Piccolo, F., de Tourtchaninoff, M., Varghese, P., Zuliani, C., Campo, G., Gatta, A., Guerit, J.M. 1999. Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol 110: 1334–1344

    Article  PubMed  CAS  Google Scholar 

  • Atterbury, C.E., Maddrey, W., Conn, H.O. 1978. Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trial. Am J Dig Dis. 23: 398–406

    Article  PubMed  CAS  Google Scholar 

  • Bajaj, J.S., Etemadian, A., Hafeezullah, M., Saeian, K. 2007a. Testing for minimal hepatic encephalopathy in the United States: An AASLD survey. Hepatology 45 (3): 833–834

    Article  Google Scholar 

  • Bajaj, J.S., Saeian, K., Verber, M.D., Hischke, D., Hoffmann, R.G., Franco, J., Varma, R.R., Rao, S.M. 2007b. Inhibitory control test is a simple method to diagnose minimal hepatic encephalopathy and predict development of overt hepatic encephalopathy. Am J Gastroenterol 102: 1–7

    Article  Google Scholar 

  • Bhatia, V., Batra, Y., Acharya, S.K. 2004. Prophylactic phenytoin does not improve cerebral edema or survival in acute liver failure — a controlled clinical trial. J Hepatology 41: 89–96

    Article  CAS  Google Scholar 

  • Bhatia, V., Singh, R., Acharya, S.K. 2006. Predictive value of arterial ammonia for complications and outcome in acute liver failure. GUT 55 (1): 98–104

    Article  PubMed  CAS  Google Scholar 

  • Bianchi, G.P., Marchesini, G., Fabbri, A., Rondelli, A., Bugianesi, E., Zoli, M., Pisi, E. 1993. Vegetable versus animal protein diet in cirrhotic patients with chronic encephalopathy: A randomized cross-over comparison. J Intern Med 233: 385–392

    Article  PubMed  CAS  Google Scholar 

  • Blei, A.T., Olafsson, S., Webster, S., Levy, R. 1993. Complications of intracranial pressure monitoring in fulminant hepatic failure. Lancet 341: 157–158

    Article  PubMed  CAS  Google Scholar 

  • Bustamante, J., Rimola, A., Ventura, P.J., Navasa, M., Cirera, I., Reggiardo, V., Rodes, J. 1999. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol 30: 890–895

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Campellone, J.V., Lacomis, D., Giuliani, M.J., Kroboth, F.J. 1996. Hepatic myelopathy. Case report with review of the literature. Clin Neurol Neurosurg 98: 242–246

    Article  PubMed  CAS  Google Scholar 

  • Canalese, J., Gimson, A.E., Davis, C., Mellon, P.J., Davis, M., Williams, R. 1982. Controlled trial of dexamethasone and mannitol for the cerebral edema of fulminant hepatic failure. Gut 23: 625–629

    Article  PubMed  CAS  Google Scholar 

  • Cordoba, J., Cabrera, J., Lataif, L., Penev, P., Zee, P., Blei, A.T. 1998. High prevalence of sleep disturbances in cirrhosis. Hepatology 27: 339–345

    Article  PubMed  CAS  Google Scholar 

  • Cordoba, J., Lopez-Hellin, J., Planas, M., Sabin, P., Sanpedro, F., Castro, F., Esteban, R., Guardia, J. 2004. Normal protein diet for episodic hepatic encephalopathy: Results of a randomized study. J Hepatol 41: 38–43.

    Article  PubMed  CAS  Google Scholar 

  • Davies, M.G., Rowan, M.J., Feely, J. 1991. EEG and event related potentials in hepatic encephalopathy. Metab Brain Dis 1991; 6: 175–186.

    Article  CAS  Google Scholar 

  • Ellis, A.J., Wendon, J.A., Williams, R. 2000. Subclinical seizure activity and prophylactic phenytoin infusion in acute liver failure: A controlled clinical trial. Hepatology 32: 536–541

    Article  PubMed  CAS  Google Scholar 

  • Ferenci, P., Lockwood, A.H., Mullen, K., Tarter, R., Weissenborn, K., Blei, A.T. 2002. Hepatic encephalopathy — definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congress of Gastroenterology. Vienna 1998; Hepatology 35(3): 716–721

    Google Scholar 

  • Gitlin, N., Lewis, D.C., Hinkley, L. 1986. The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy ambulant non-shunted patients with cirrhosis. J Hepatol 3: 75–82

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  • Homburg, A.M., Jacobsen, M., Enevoldsen, E. 1993. Transcranial doppler recordings in raised intracranial pressure. Acta Neurol Scand 87: 488–493

    Article  PubMed  CAS  Google Scholar 

  • Hui, A.Y., Chan, H.L., Leung, N.W., Hung, L.C., Chan, F.K., Sung, J.J. 2002. Survival and prognostic indicators in patients with hepatitis B virus-related cirrhosis after onset of hepatic decompensation. J Clin Gastroenterol 34(5): 569–572

    Article  PubMed  Google Scholar 

  • Jalan, R., Olde Damink, S.W., Deutz, N.E., Hayes, P.C., Lee, A. 2004. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology 127: 1338–1346

    Article  PubMed  CAS  Google Scholar 

  • Kircheis, G., Nilius, R., Held, C., Berndt, H., Buchner, M., Görtelmeyer, R., Hendricks, R., Kruger, B., Kuklinski, B., Meister, H., Otto, H.J., Rink, C., Rosch, W., Stauch, S. 1997. Therapeutic efficacy of L-Ornithine-L-Aspartate infusions in patients With cirrhosis and hepatic encephalopathy: Results of a placebo-controlled, double-blind study. Hepatology 25: 1351–1360

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Kril, J.J., Butterworth, R.F. 1997. Diencephalic and cerebellar pathology in alcoholic and non-alcoholic patients with end-stage liver disease. Hepatology 26 (4): 837–841

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Larsen, F.S., Ejlersen, E., Hansen, B.A., Knudsen, G.M., Tygstrup, N., Secher, N.H. 1995a. Functional loss of cerebral blood flow autoregulation in patients with fulminant hepatic failure. J Hepatol 23: 212–217

    Article  CAS  Google Scholar 

  • Larsen, F.S., Pott, F., Hansen, B.A., Ejlersen, E., Knudsen, G.M., Clemmesen, J.D., Secher, N.H. 1995b. Transcranial doppler sonography may predict brain death in patients with fulminant hepatic failure. Transpl Proc 27 (6): 3510–3511

    CAS  Google Scholar 

  • Leevy, C.B., Phillips, J.A. 2007. Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci; 52: 737–741

    Article  PubMed  CAS  Google Scholar 

  • Lockwood, A.H. 2000. “What’s in a name?” Improving the care of cirrhotics. J Hepatol 32: 859–861

    Article  PubMed  CAS  Google Scholar 

  • Lockwood, A.H., Butterworth, R.F., Weissenborn, K. 1997. An image of the brain in liver disease. Curr Opin Neurol 10(6): 525–533

    Article  PubMed  CAS  Google Scholar 

  • Lockwood, A.H., Murphy, B.W., Donnelly, K.Z., Mahl, T.C., Perini, S. 1993. Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 18 (5): 1061–1068

    Article  PubMed  CAS  Google Scholar 

  • Lockwood, A.H., Weissenborn, K., Bokemeyer, M., Tietge, U., Burchert, W. 2002. Correlations between cerebral glucose metabolism and neuropsychological test performance in non-alcoholic cirrhotics. Metab Brain Dis 17(1): 29–40

    Article  PubMed  Google Scholar 

  • Marchesini, G., Bianchi, G., Merli, M., Amodio, P., Panella, C., Loguercio, C., Rossi Fanelli, F., Abbiati, R., and Italian BCAA Study Group. 2003. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: A double-blind, randomized trial. Gastroenterology 124: 1792–1801

    Article  PubMed  CAS  Google Scholar 

  • Marchesini, G., Fabbri, A., Bianchi, G., Brizi, M., Zoli, M. 1996. Zinc supplementation and amino-acid-nitrogen metabolism in patients with advanced cirrhosis. Hepatology 23: 1084–1092

    Article  PubMed  CAS  Google Scholar 

  • Mas, A., Rodes, J., Sunyer, L., Rodrigo, L., Planas, R., Vargas, V., Castells, L., Rodriguez-Martinez, D., Fernandez-Rodriguez, C., Coll, I., Pardo, A.;, Spanish Association for the study of the Liver Hepatic Encephalopathy Cooperative Group. 2003. Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: Results of a randomized, double-blind, double-dummy, controlled clinical trial. J Hepatol. 38: 51–58.

    Article  PubMed  CAS  Google Scholar 

  • Montagnese, S., Amodio, P., Morgan, M.Y. 2004. Methods for diagnosing hepatic encephalopathy in patients with cirrhosis: A multidimensional approach. Metab Brain Dis 19: 281–312

    Article  PubMed  Google Scholar 

  • Montagnese, S., Jackson, C., Morgan, M.Y. 2007. Spatio-temporal decomposition of the electroencephalogram in patients with cirrhosis. J Hepatol 46: 447–458

    Article  PubMed  Google Scholar 

  • Morgan, M.Y., Alonso, M., Stanger, L.C. 1989. Lactitol and lactulose for the treatment of subclinical hepatic encephalopathy in cirrhotic patients. J Hepatol 8: 208–217

    Article  PubMed  CAS  Google Scholar 

  • Morgan, M.Y., Hawley, K.E. 1987. Lactitol versus lactulose in the treatment of acute hepatic encephalopathy in cirrhotic patients: a double-blind, randomized trial. Hepatology 7(6): 1278–1284

    Article  PubMed  CAS  Google Scholar 

  • Munoz, S.J. 1993. Difficult management problems in fulminant hepatic failure. Semin Liver Disease 13: 395–413

    Article  CAS  Google Scholar 

  • Murphy, N., Auzinger, G., Bernal, W., Wendon, J. 2004. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology 39: 464–470

    Article  PubMed  CAS  Google Scholar 

  • Muto, Y., Sato, S., Watanabe, A., Moriwaki, H., Suzuki, K., Kato, A., Kato, M., Nakamura, T., Higuchi, K., Nishiguchi, S., Kumada, H., Ohashi, Y.;, for the Long-Term-Survival Study (LOTUS) Group. 2005. Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol. 3: 705–713.

    Article  PubMed  CAS  Google Scholar 

  • O’Grady, J.G., Schalm, S.W., Williams, R. 1993. Acute liver failure: Redefining the syndromes. Lancet 342: 273–275

    Article  PubMed  Google Scholar 

  • Ostapowicz, G.A., Fontana, R.J., Schiodt, F.V., Larson, A., Davern, T.J., Han, S.H., McCashland, T.M., Shakil, A.O., Hay, J.E., Hynan, L., Crippin, J.S., Blei, A.T., Samuel, G., Reisch, J., Lee, W.M.;, U.S. Acute Liver Failure Study Group. 2002. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 137: 947–954

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  • Penin, H. 1967. Über den diagnostischen Wert des Hirnstrombildes bei der hepato-portalen Encephalopathie. Fortschr Neurol Psychiatr 35 (4): 174–234

    CAS  Google Scholar 

  • Polson, J., Lee, W.M. 2005. AASLD position paper: The management of acute liver failure. Hepatology 41(5): 1179–1197

    Article  PubMed  Google Scholar 

  • Poo, J.L., Gongora, J., Sanchez-Avila, F., Aguilar-Castillo, S., Garcia-Ramos, G., Fernandez-Zertuche, M., Rodriguez-Fragoso, L., Uribe, M. 2006. Efficacy of oral L-ornithine-L-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study. Ann Hepatol 5(4): 281–288

    PubMed  Google Scholar 

  • Powell, E.E., Pender, M.P., Chalk, J.B., Parkin, P.J., Strong, R., Lynch, S., Kerlin, P., Cooksley, W.G., Cheng, W., Powell, L.W. 1990. Improvement in chronic hepatocerebral degeneration following liver transplantation. Gastroenterology 98: 1079–1082

    Article  PubMed  CAS  Google Scholar 

  • Prasad, S., Dhiman, R.K., Duseja, A., Chawla, Y.K., Sharma, A., Agarwal, R. 2007. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45: 549–559

    Article  PubMed  Google Scholar 

  • Quadri, A.M., Ogunwale, B.O., Mullen, K.D. 2007. Can we ignore minimal hepatic encephalopathy any longer. Hepatology 45: 547–548

    Article  Google Scholar 

  • Raghavan, M., Marik, P.E. 2006. Therapy of intracranial hypertension in patients with fulminant hepatic failure. Neurocrit Care 4: 179–189

    Article  PubMed  CAS  Google Scholar 

  • Riggio, O., Ariosto, F., Merli, M., Caschera, M., Zullo, A., Balducci, G., Ziparo, V., Pedretti, G., Fiaccodori, F., Bottari, E. et al. 1991. Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy: results of a double-blind crossover trial. Dig Dis Sci 36: 1204–1208

    Article  PubMed  CAS  Google Scholar 

  • Rinella, M.E., Sanyal, A. 2006. Intensive management of hepatic failure. Sem Respiratory Crit Care Med 27(3): 241–261

    Article  Google Scholar 

  • Romero-Gomez, M., Cordoba, J., Jover, R., Del Olmo, J.A., Ramirez, M., Rey, R., de Madaria, E., Montoliu, C., Nunez, D., Flavia, M., Company, L., Rodrigo, J.M., Felipo, V. 2007. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology 45(4): 879–885

    Article  PubMed  Google Scholar 

  • Sass, D.A., Shakil, A.O. 2005. Fulminant hepatic failure. Liver Transplantation 11(6): 594–605

    Article  PubMed  Google Scholar 

  • Schnittger, C., Weissenborn, K., Böker, K., Kolbe, H., Dengler, R., Manns, M.P. 1997. Continuous noninvasive cerebral perfusion monitoring in fulminant hepatic failure and brain oedema. In Advances in Hepatic Encephalopathy & Metabolism in Liver Disease. eds C. Record and H. Al Mardini (eds.)., pp. 515–519. New Castle upon Tyne: Medical Faculty of the University of Newcastle upon Tyne

    Google Scholar 

  • Schomerus, H., Hamster, W. 1998. Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 13(4): 361–377

    Article  PubMed  CAS  Google Scholar 

  • Schomerus, H., Hamster, W. 2001. Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab Brain 16 (1/2): 37–42

    Article  CAS  Google Scholar 

  • Schomerus, H., Hamster, W., Blunck, H., Reinhard, U., Mayer, K., 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

    Article  PubMed  CAS  Google Scholar 

  • Schomerus, H., Schreiegg, J. 1993. Prevalence of latent portasystemic encephalopathy in an unselected population of patients with liver cirrhosis in general practice. Z Gastroenterol 31: 231–234

    PubMed  CAS  Google Scholar 

  • Schomerus, H., Weissenborn, K., Hamster, W., Rueckert, N., Hecker, H. 1999. PSE-syndrom-test. Psychodiagnostisches Verfahren zur quantitativen Erfassung der (minimalen) portosystemischen Enzephalopathie. Frankfurt: Swets Test Services.

    Google Scholar 

  • Shami, V.M., Caldwell, S.H., Hespenheide, E.E., Arseneau, K.O., Blickston, S.J., Macik, B.G. 2003. Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy. Liver Transpl 9: 138–143

    Article  PubMed  Google Scholar 

  • Sherlock, S., Summerskill, W.H.J., White, L.P., Phear, E.A. 1954. Portal-systemic encephalopathy. Neurological complications of liver disease. Lancet I: 453–457

    Article  Google Scholar 

  • Spahr, L., Butterworth, R.F., Fontaine, S., Bui, L., Therrien, G., Milette, P.C., Lebrun, L.H., Zayed, J., Leblanc, A., Pomier-Layrargues, G. 1996. Increased blood manganese in cirrhotic patients: Relationship to pallidal magnetic resonance signal hyperintensity and neurological symptoms. Hepatology 1996; 24: 1116–1120

    Article  CAS  Google Scholar 

  • Srivastava, A., Mehta, R., Rothke, S.P., Rademaker, A.W., 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

    Article  PubMed  CAS  Google Scholar 

  • Stauch, S., Kircheis, G., Adler, G., Beckh, K., Ditschuneit, H., Görtelmeyer, R., Hendricks, R., Heuser, A., Karoff, C., Malfertheiner, P., Mayer, D., Rosch, W., Steffens, J. 1998. Oral L-ornithine-L-aspartate therapy of chronic hepatic encephalopathy: Results of a placebo-controlled double-blind study. J Hepatol 28: 856–864

    Article  PubMed  CAS  Google Scholar 

  • Tofteng, F., Larsen, F.S. 2004. The effect of indomethacin on intracranial pressure, cerebral perfusion and extracellular lactate and glutamate concentrations in patients with fulminant hepatic failure. J Cereb Blood Flow Metab 24: 798–804

    Article  PubMed  CAS  Google Scholar 

  • Van der Rijt, C.D.C., Schalm, S., De Groot, G.H., De Vlieger, M. 1990. Objective measurement of hepatic encephalopathy by means of automated EEG analysis. Electroencephalogr Clin Neurophysiol 75: 289–295

    Article  Google Scholar 

  • Van der Rijt, K., Schalm, S.W., Schat, H., Foeken, K., De Jong, G. 1991. Overt hepatic encephalopathy precipitated by zinc deficiency. Gastroenterology 100: 114–118

    Google Scholar 

  • Vaquero, J., Fontana, R.J., Larson, A.M., Bass, N.M.T., Davern, T.J., Shakil, A.O., Han, S., Harrison, M.E., Stravitz, T.R., Munoz, S., Brown, R., Lee, W.M., Blei, A.T. 2005. Complications and use of intracranial pressure monitoring in patients with acute liver failure and severe encephalopathy. Liver Transpl 12: 1581–1589

    Article  Google Scholar 

  • Victor, M., Adams, R.D., Cole, M. 1965. The acquired (non-Wilsonina) type of chronic hepatocerebral degeneration. Medicine (Baltimore) 44: 345–394

    Article  CAS  Google Scholar 

  • Watanabe, A., Tuchida, T., Yata, Y., Kuwabara, J. 1995. Evaluation of neuropsychological function in patients with liver cirrhosis with special reference to their driving ability. Metab Brain Dis. 10: 239–248

    Article  PubMed  CAS  Google Scholar 

  • Wein, C., Koch, H., Popp, B., Oehler, G., Schauder, P. 2004. Minimal hepatic encephalopathy impairs fitness to drive. Hepatology 39: 739–745

    Article  PubMed  Google Scholar 

  • Weissenborn, K. 1991. Neurophysiological methods in the diagnosis of Eearly hepatic encephalopathy. In Progress in Hepatic Encephalopathy and Metabolic Nitrogen Exchange. Bengtsson F, Jeppsson B, Almdal T, Vilstrup H (eds.)., pp 27–39. Boca Raton: CRC Press

    Google Scholar 

  • Weissenborn, K., Ennen, J.C., Schomerus, H., Ruckert, N., Hecker, H. 2001. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 34: 768–773.

    Article  PubMed  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  • Weissenborn, K., Tietge, U.J., Bokemeyer, M., Mohammadi, B., Bode, U., Manns, M.P., Caselitz, M. 2003. Liver transplantation improves hepatic myelopathy: Evidence by three cases. Gastroenterology. 2003; 124: 346–351

    Article  Google Scholar 

  • White, M.L., Zhang, Y., Andrew, L.G., Hadley, W.L. 2005. MR imaging with diffusion-weighted imaging in acute and chronic wernicke encephalopathy. AJNR 26: 2306–2310

    PubMed  Google Scholar 

  • Zhong, C., Jin, L., Fei, G. 2005. MR imaging of nonalcoholic wernicke encephalopathy: A follow-up study. AJNR 26: 2301–2305

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Weissenborn, K. (2009). Hepatic Encephalopathy. In: McCandless, D. (eds) Metabolic Encephalopathy. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79112-8_10

Download citation

Publish with us

Policies and ethics