Skip to main content
SpringerLink
Log in

Imaging studies in hepatic encephalopathy

  • Chapter
Encephalopathy and Nitrogen Metabolism in Liver Failure

Abstract

For decades, insights into the pathophysiology of hepatic encephalopathy (HE) had to be achieved using animal models, such as the portacaval shunted rat, or cell cultures. However, recent developments in brain imaging techniques, such as magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), single photon emission tomography (SPECT) and positron emission tomography (PET) provide new opportunities to study in vivo structural and metabolic changes, or even altered neurotransmission, in the brain of patients with HE.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
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

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Morgan MY. Cerebral magnetic resonance imaging in patients with chronic liver disease. Metab Brain Dis 1998; 13:273–290.

    Article  PubMed  CAS  Google Scholar 

  2. Inoue E, Hon S, Narumi Y, Fujita M, Kuriyama K, Kadota T and Kuroda C. Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images. Radiology 1991; 179:551–555.

    PubMed  CAS  Google Scholar 

  3. Kulisevsky J, Pujol J, Balanzo J, Junque C, Deus J, Capdevilla A and Villanueva C. Pallidal hyperintensity on magnetic resonance imaging in cirrhotic patients: clinical correlations. Hepatology 1992; 16:1382–1388.

    Article  PubMed  CAS  Google Scholar 

  4. Pujol A, Pujol J, Graus F, Rimola A, Peri J, Mercader JM et al. Hyperintense globus pallidus on Tl-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology 1993; 43: 65–69.

    Article  PubMed  CAS  Google Scholar 

  5. Weissenborn K, Ehrenheim Ch, Hori A, Kubicka S and Manns MP. Pallidal lesions in patients with liver cirrhosis: clinical and MRI evaluation. Metab Brain Dis 1995; 10: 219–238.

    Article  PubMed  CAS  Google Scholar 

  6. Brunberg JA, Kanal E, Hirsch W and Van Thiel DH. Chronic acquired hepatic failure: MR imaging of the brain at 1.5 T. Am J Neuroradiol 1991; 12: 909–914.

    PubMed  CAS  Google Scholar 

  7. Pomier-Layrargues G, Spahr L and Butterworth RF. Increased manganese concentrations in pallidum of cirrhotic patients. Lancet 1995; 345:735.

    Article  PubMed  CAS  Google Scholar 

  8. Krieger D, Krieger S, Jansen O, Gass P, Theilmann L and Lichtenecker H. Manganese and chronic hepatic encephalopathy. Lancet 1995; 346: 270–274.

    Article  PubMed  CAS  Google Scholar 

  9. Pomier-Layrargues G, Rose C, Spahr L, Zayed J, Normandin L and Butterworth RF. Role of manganese in the pathogenesis of portal-systemic encephalopathy. Metab Brain Dis 1998; 13:311–318.

    Article  Google Scholar 

  10. Bergeron M, Reader TA, Pomier-layrargues G and Butterworth RF. Monoamines and metabolites in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy. Neurochem Res 1989; 14:853–859.

    Article  PubMed  CAS  Google Scholar 

  11. Weissenborn K., Berding G. and Köstler H. Altered striatal dopamine receptor density and dopamine transport in a patient with hepatic encephalopathy. Metab Brain Dis 2000; 15:173–178.

    PubMed  CAS  Google Scholar 

  12. Raghavendra Rao VL, Giguere JF, Pomier-Layrargues G and Butterworth RF. Increased activities of MAO A and MAO B in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy. Brain Res 1993;621:349–352.

    Article  Google Scholar 

  13. Norenberg MD. Astroglial dysfunction in hepatic encephalopathy. Metab Brain Dis 1998; 13: 319–336.

    Article  PubMed  CAS  Google Scholar 

  14. Butterworth RF. Alterations of neurotransmitter-related gene expression in human and experimental portal-systemic encephalopathy. Metab Brain Dis 1998; 13: 337–350.

    Article  PubMed  CAS  Google Scholar 

  15. Iwasa M, Kinosada Y, Watanabe S, Furuta M, Yuda H, Kawamura N, Nakayabu M, Esaki A, Sato T, Deguchi T, Nakatsuka A and Adachi Y. Hepatic cirrhosis: magnetisation transfer contrast in the globus pallidus. Neuroradiology 1998; 40: 145–149.

    Article  PubMed  CAS  Google Scholar 

  16. Iwasa M, Kinosada Y, Nakatsuka A, Watanabe S and Adachi Y. Magnetization transfer contrast of various regions of the brain in liver cirrhosis. Am J Neuroradiol 1999; 20: 652–654.

    PubMed  CAS  Google Scholar 

  17. Rovira A, Grive E, Pedraza S, Rovira A and Alonso J. Magnetization transfer ratio values and proton MR spectroscopy of normal-appearing cerebral white matter in patients with liver cirrhosis. Am J Neuroradiol 2001; 22: 1137–1142.

    PubMed  CAS  Google Scholar 

  18. Köstler H. Proton magnetic resonance spectroscopy in portal-systemic encephalopathy. Metab Brain Dis 1998; 13:291–301.

    Article  PubMed  Google Scholar 

  19. Kreis R, Ross BD, Farrow NA and Ackerman Z. Metabolic disorder of the brain in chronic hepatic encephalopathy detected with H-l MR spectroscopy. Radiol 1992; 182: 19–27.

    CAS  Google Scholar 

  20. Laubenberger J, Häussinger D, Bayer S, Gufler H, Hennig J and Langer M. Proton magnetic resonance spectroscopy of the brain in symptomatic and asymptomatic patients with liver cirrhosis. Gastroenterology 1997; 112: 1610–1616.

    Article  PubMed  CAS  Google Scholar 

  21. Lockwood AH, Weissenborn K and Butterworth RF. An image of the brain in patients with liver disease. Curr Opin Neurol 1997; 10: 525–533.

    Article  PubMed  CAS  Google Scholar 

  22. Isaacks RE, Bender AS, Kim CY, Shi YF and Norenberg MD. Effect of ammonia and methionine sulfoximine on myo-inositol uptake in cultured astrocytes. Neurochem Res 1999; 24: 51–59

    Article  PubMed  CAS  Google Scholar 

  23. Schliess F, Sinnig R, Fischer R, et al. Calcium-dependent activation of Erk-1 and Erk-2 following hypoosmotic astrocyte-swelling. Biochem J 1996; 320: 167–171.

    PubMed  CAS  Google Scholar 

  24. Fischer R, Schliess F and Häussinger D. Characterization of the hypoosmotically-induced Ca2+ response in primary astrocytes. Glia 1997; 20: 51–58.

    Article  PubMed  CAS  Google Scholar 

  25. Häussinger D, Kircheis G and Fischer R et al. Hepatic encephalopathy in chronic liver disease: a clinical manifestation of astrocyte swelling and low-grade cerebral edema? J Hepatol 2000; 32: 1035–1038.

    Article  PubMed  Google Scholar 

  26. Sherlock S, Summerskill WHJ, White LP and Phear EA. Portal-systemic encephalopathy. Neurological complications of liver disease. Lancet 1954; i: 453–457.

    Article  Google Scholar 

  27. Read A, Sherlock S, Laidlaw J and Walker JG. The neuro-psychiatric syndromes associated with chronic liver disease and an extensive portal-systemic collateral circulation. Quart J Med 1967; 114: 135–150.

    Google Scholar 

  28. Weissenborn K and Kolbe H. The basal ganglia and portal-systemic encephalopathy. Metab Brain Dis 1998; 13: 261–272.

    Article  PubMed  CAS  Google Scholar 

  29. Pomier-Layrargues G. Movement dysfunction and hepatic encephalopathy. Metab Brain Dis 2001;16: 27–36.

    Article  Google Scholar 

  30. Krieger S, Jauß M, Jansen O et al. Neuropsychiatrie profile and hyperintense globus pallidus on Tl-weighted magnetic resonance images in liver cirrhosis. Gastroenterology 1996; 111: 147–155.

    Article  PubMed  CAS  Google Scholar 

  31. Weissenborn K, Ennen, JC, Schomerus H, Rückert N and Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001; 34:768–773.

    Article  PubMed  CAS  Google Scholar 

  32. Lockwood AH, Yap EW, Rhoades HM and Wong WH. Altered cerebral blood flow and glucose metabolism in patients with liver disease and minimal hepatic encephalopathy. J Cereb Blood How Metab 1991;11:331–336.

    Article  CAS  Google Scholar 

  33. Lockwood AH, Yap EW and Wong WH. Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 1991; 11: 337–341.

    Article  PubMed  CAS  Google Scholar 

  34. Lockwood AH, Murphy BW, Donnelly KZ, Mahl TC and Perini S. Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 1993; 18:1061–1068.

    Article  PubMed  CAS  Google Scholar 

  35. Lockwood AH, Weissenborn K, Bokemeyer M, Tietge U and Burchert W. Correlations between cerebral glucose metabolism and neuropsychological test performance in nonalcoholic cirrhotics. Metab Brain Dis 2002; 17:29–40.

    Article  PubMed  Google Scholar 

  36. Schomerus H, Weissenborn K, Hamster W, Rückert N and Hecker H. PSE-Syndrom-Test.Swets Test Services, Swets & Zeitlinger B.V., Frankfurt, 1999.

    Google Scholar 

  37. Ermen JC, Bokemeyer M, Ahl B, Krause J, Giewekemeyer K, Heidemann M, Ellringmann U, Hecker H and Weissenborn K. Re-evaluation of the psychometric hepatic encephalopathy score (PHES). 11th International Symposium on Hepatic Encephalopathy and Nitrogen Metabolism, Amsterdam, 2002 (abstract).

    Google Scholar 

  38. Tarter RE, Hegedus AM, Van Thiel DH, Schade RR, Gavaler JS and Starzl TE. Non-alcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 1984; 86:1421–1427.

    PubMed  CAS  Google Scholar 

  39. Tarter RE, Arria AM, Carra J and Van Thiel DH. Memory impairments concomitant with non-alcoholic cirrhosis. Intern J Neurosci 1987; 32:853–859.

    Article  CAS  Google Scholar 

  40. Weissenborn K, Heidenreich S, Giwekemeyer K, Rückert N and Hecker H. Pathological memory test results in minimal hepatic encephalopathy do not prove memory dysfunction. 11th International Symposium on Hepatic Encephalopathy and Nitrogen Metabolism, Amsterdam, 2002 (abstract).

    Google Scholar 

  41. Ahl B, van den Hoff J, Bokemeyer M, Giewekemeyer K, Berding G, Burchert W, Hecker H and Weissenborn K. Sequence of regional differences of cerebral glucose uptake in cirrhotic patients with hepatic encephalopathy. 11th International Symposium on Hepatic Encephalopathy and Nitrogen Metabolism, Amsterdam, 2002 (abstract).

    Google Scholar 

  42. Wiser AK, Andreasen NC, O’Leary DS, Watkins GL, Boles Ponto LL and Hichwa RD. Dysfunctional cortico-cerebellar circuits cause ‘cognitive dysmetria’ in schizophrenia. Neuroreport 1998; 9:1895–1899.

    Article  PubMed  CAS  Google Scholar 

  43. Schomerus G, Giewekememyer K, Berding G, Ahl B, Ennen JC and Weissenborn K. Influence of cerebellar neuronal function on word learning in patients with hepatic encephalopathy. 11th International Symposium on Hepatic Encephalopathy and Nitrogen Metabolism, Amsterdam, 2002 (abstract).

    Google Scholar 

  44. Giewekemeyer K, Berding G, Ennen JC, Ahl B and Weissenborn K. Correlation between cerebral glucose metabolism and motor dysfunction in early hepatic encephalopathy (HE). 11th International Symposium on Hepatic Encephalopathy and Nitrogen Metabolism, Amsterdam, 2002 (abstract).

    Google Scholar 

  45. Joebges EM, Heidemann M and Weissenborn K. Three dimensional computer assisted movement analysis in patients with hepatic encephalopathy — preliminary results. In: Yurdaydin C, Bozkaya H (Eds). Advances in Hepatic Encephalopathy and Metabolism in Liver Disease. Ankara: Medical Faculty University of Ankara, 2000; 271–280.

    Google Scholar 

  46. Ahl B, Fischer-Wasels D, van den Hoff J, Burchert W and Weissenborn K. Cerebral Ammonia-, H2O-and Glucose-PET in cirrhotics with minimal hepatic encephalopathy (HE). J Hepatol 2000; 32(Suppl. 2): 146 (abstract).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany

    B. Ahl, M. Bokemeyer, K. Giewekemeyer, G. Schomerus, D. Fischer-Wasels, J. C. Ennen & K. Weissenborn

  2. Department of Neuroradiology, Medizinische Hochschule Hannover, Hannover, Germany

    M. Bokemeyer

  3. Department of Nuclear Medicine, Medizinische Hochschule Hannover, Hannover, Germany

    W. Burchert, J. van den Hoff & G. Berding

Authors
  1. B. Ahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Bokemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Giewekemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Schomerus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Fischer-Wasels
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. C. Ennen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. W. Burchert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. van den Hoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G. Berding
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K. Weissenborn
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands

    E. Anthony Jones  & Robert A. F. M. Chamuleau  & 

  2. Department of Biochemistry, Academic Medical Center, Amsterdam, Netherlands

    Alfred J. Meijer

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Ahl, B. et al. (2003). Imaging studies in hepatic encephalopathy. In: Jones, E.A., Meijer, A.J., Chamuleau, R.A.F.M. (eds) Encephalopathy and Nitrogen Metabolism in Liver Failure. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-0159-5_12

Download citation

  • DOI: https://doi.org/10.1007/978-94-010-0159-5_12

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3967-3

  • Online ISBN: 978-94-010-0159-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation