Cognitive Dysfunction in Latent Portasystemic Encephalopathy

  • Arthur A. Dunk
  • John W. Moore


Portasystemic encephalopathy (PSE) is a neuropsychiatric disorder which occurs as a complication of both acute and chronic liver diseases. This syndrome has traditionally been divided into several crude but easily recognisable clinical grades (Parsons-Smith et al., 1957), ranging from grade I (impairment of concentration, trivial mood changes, impaired ability to draw a five-pointed star) at one extreme through to grade IV (coma) at the other. More recently, the use of psychometric testing has revealed that many cirrhotic patients, who have no evidence of PSE on clinical examination, suffer from significant neuropsychological deficits. These patients are termed to have ‘latent’ or ‘sub-clinical’ PSE (Schomerus & Hamster, 1976; Rikkers et al., 1978; Schomerus et al., 1981; Gitlin et al., 1986). This increasingly recognised category of PSE is of importance as the neuropsychological deficits involved are often those of performance skills, and may therefore lead to impairment of a patient’s abilities to safely perform important activities of daily living (Rehnström et al., 1977; Rikkers et al., 1978; Schomerus et al., 1981; Gitlin et al., 1986).


Hepatic Encephalopathy Cirrhotic Patient Visual Evoke Potential Neuropsychological Deficit Subtest Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Bernthal, P., Hays, A., Tarter, R.E., Van Thiel, D., Lecky, J. & Hegedus, A. (1987). Cerebral CT scan abnormalities in cholestatic and hepatocellular disease and their relationship to neuropsychologic test performance. Hepatology, 7 107–111.Google Scholar
  2. Borg, J., Warter, J.M., Schlienger, J.L., Imler, M., Marescaux, C. & Mack, G. (1982). Neurotransmitter modifications in human cerebrospinal fluid and serum during hepatic encephalopathy. Journal of Neurological Science, 57 343–356.Google Scholar
  3. Conn, H.O. (1977). Trailmaking and Reitan connection tests in the assessment of mental state in portal systemic encephalopathy. American Journal of Digestive Diseases, 22 541–550.Google Scholar
  4. Dunk, A.A., Moore, J., Symon, A., Dickie, A., Sinclair, T.S., Mowat, N.A.G. & Brunt, P.W. (1988). The effects of propranolol on hepatic encephalopathy in patients with cirrhosis and portal hypertension. Alimentary Pharmacology and Therapeutics, 2 143–152.Google Scholar
  5. Egberts, E-H., Schomerus, H., Hamster, W. & Jurgens, P. (1985). Branched chain amino acids in the treatment of latent portasystemic “éncephalopathy: a double-blind placebo-controlled crossover study. Gastroenterology, 88 887–895.Google Scholar
  6. Field, J.G. (1960). Two types of tables for use with Wechsler’s intelligence scales. Journal of Clinical Psychology, 16 3–7.Google Scholar
  7. Gilberstadt, S.J.,Gilberstadt, H., Zieve, L., Buegel, B., Collier, R.O. & McClain, C.J. (1980). Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Archives of Internal Medicine, 140 519–521.Google Scholar
  8. 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. Journal of Hepatology, 3 75–82.Google Scholar
  9. Jones, E.A. & Schafer, D.F. (1986). Hepatic encephalopathy: a neurochemical disorder. Seminars in Liver Disease, VIII 525–540.Google Scholar
  10. Levy, L.J., Bolton, R.P. & Losowsky, M.S. (1987). The use of visual evoked potentials (VEP) in delineating a state of subclinical encephalopathy: a comparison with the number connection test (NCT). Journal of Hepatology, 5 211–217.Google Scholar
  11. McClain, C.J., Potter, T.J., Kromhout, J.P. & Zieve, L. (1984). The effect of lactulose on psychomotor performance tests in alcoholic cirrhotics without overt hepatic encephalopathy. Journal of Clinical Gastroenterology, 6 325–329.Google Scholar
  12. Messori, E., Zani, G. & Ventura, E. (1984). Visual evoked potential: a diagnostic tool for the assessment of hepatic encephalopathy. Gut 25, 291–299.Google Scholar
  13. Moore, J.W., Dunk, A.A., Crawford, J.R., Deans, H., De Lacey, G., Besson, J., Sinclair, T.S. Mowat, N.A.G. & Brunt, P.W. Psychometric deficits and morphological NMR brain scan abnormalities in apparently ‘healthy’ non-encephalpathic patients with cirrhosis: a controlled study. Submitted for publication.Google Scholar
  14. Parsons-Smith, B.G., Summerskill, W.H.J., Dawson, A.M. & Sherlock, S. (1957). The electroencephalograph in liver disease. Lancet, ii 867–871.Google Scholar
  15. Pierelli, F., Pozzessere, G., Sanarelli, L., Valle, E., Rizzo, P.A. & Morocutti, G. (1985). Electrophysiological study in patients with chronic hepatic insufficiency. Acta Neurologica Belgica, 85 284291.Google Scholar
  16. Rehnstrom, S., Simert, S., Hansson, J.A., Johnson, G. & Vang, J. (1977). Chronic hepatic encephalopathy. A psychometrical study. Scandinavian Journal of Gastroenterology, 12 305–311.Google Scholar
  17. Rikkers, L., Jenko., P., Rudman, D. & Freides, D. (1978). Subclinical hepatic encephalopathy detection, prevalence and relationship to nitrogen metabolism. Gastroenterology, 75 462–469.Google Scholar
  18. Rossi-Fanelli, F., Strom, C.R., Cardelli-Gangiano, P., Ceci, F., Muscaritoli, M. & Cangiano, C. (1987). Amino acids and hepatic encephalopathy. Progress in Neurobiology, 28 277–301.Google Scholar
  19. Sarin, S.K. & Nundy, S. (1985). Subclinical encephalopathy after porta-systemic shunts in patients with non-cirrhotic portal fibrosis. Liver, 5 142–146.Google Scholar
  20. Schomerus, H. & Hamster, W. (1976). Latent portasystemic encephalopathy. Digestion, 14 5–6.Google Scholar
  21. Schomerus, H., Hamster, W., Blunck, H., Reinhard, U., Mayer, K. & Dolle, W. (1981). Latent portasystemic encephalopathy. 1. nature of cerebral functional defects and their effect on fitness to drive. Digestive Diseases and Sciences, 26 622–630.Google Scholar
  22. Tarter, R.E., Edwards, K.L. & Van Thiel, D.H. (1986a). Hepatic encephalopathy. in: G. Goldstein & R.E. Tarter (eds.). Advances in Clinical Neuropsychology, Vol.3. New York: Plenum Press.Google Scholar
  23. Tarter, R.E., Hays, A.L., Sandford, S.S. & Van Thiel, D. (1986b). Cerebral morphological abnormalities associated with non-alcoholic cirrhosis. Lancet, ii 893–895.Google Scholar
  24. Yang, S-S., Chu, N-S. & Liaw, Y-F. (1985). Somatosensory evoked poten- tials in hepatic encephalopathy. Gastroenterology, 89 625–630.Google Scholar
  25. Zeegen, R., Drinkwater, J.E. & Dawson, A.M. (1970). Method for measuring cerebral dysfunction in patients with liver disease. British Medical Journal, 2 633–636.Google Scholar
  26. Zeneroli, M.L. (1985). Hepatic encephalopathy: experimental studies on a rat model of fulminant hepatic failure. Journal of Hepatology, 1 301–312.Google Scholar
  27. Zieve, L. (1981). The mechanism of hepatic coma. Hepatology, 1 360–365.Google Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Arthur A. Dunk
  • John W. Moore

There are no affiliations available

Personalised recommendations