Specific encephalopathies
Kidney Function Restoration Program
HEPATIC ENCEPHALOPATHY
Neurological signs and symptoms secondary to hepatic dysfunction may arise in:
- chronic liver failure complicated by infection or gastrointestinal haemorrhage.
- chronic liver failure producing characteristic hepatocerebral degeneration.
Clinical features:
These may be divided into two groups:
Symptoms and signs of disturbed mental state
Symptoms and signs of disturbed neurological function: Asterixis Ataxia
Myoclonus Hyperreflexia
Hemiparesis Ophthalmoplegia
Dysarthria Nystagmus
The encephalopathy is progressive. Pathology
Neuronal loss with gliosis is noted in the cerebral cortex as well as basal ganglia, cerebellum and brain stem. Astrocytes with irregular and enlarged nuclei are characteristic.
Hepatocerebral degeneration produces varying symptoms and signs. Dementia is associated with dysarthria and ataxia. Primitive reflexes, choreoathetosis, myoclonus, tremor and pyramidal signs may also be present. Consciousness is not impaired.
URAEMIC ENCEPHALOPATHY
Clinical features:
These may be divided into two groups: -Symptoms and signs of disturbed neurological function
Symptoms and signs of disturbed mental state
As in hepatic encephalopathy + generalised seizures
Pathology:
Uraemia may produce non-specific pathological findings in the nervous system. Peripheral nervous system involvement occurs in chronic renal failure (page 421).
Dialysis encephalopathy is encountered in persons on renal dialysis exposed to high aluminium levels in the dialysate. The features are those of dementia, behavioural changes, seizures and myoclonus. The condition progresses unless aluminium levels are controlled.
Specific investigations and treatment of individual metabolic encephalopathies do not come within the scope of this book.
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