Specific encephalopathies

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HEPATIC ENCEPHALOPATHY

Neurological signs and symptoms secondary to hepatic dysfunction may arise in:

- acute liver failure.

- 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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