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Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis.
Am J Gastroenterol. 2003 Jul; 98(7):1599-604.AJ

Abstract

OBJECTIVE

Two types of neurological dysfunction can occur in compensated cirrhosis: 1) extrapyramidal signs related to the accumulation of manganese in the basal ganglia and 2) milder degrees of cognitive impairment known as minimal hepatic encephalopathy (mHE). We assessed whether there was any relationship between both disorders in 42 patients with compensated cirrhosis.

METHODS

Minimal hepatic encephalopathy was diagnosed using a battery of manual neuropsychological tests. Cognitive functioning was assessed by the Mini-Mental State Examination. Extrapyramidal signs were evaluated by the Columbia scale.

RESULTS

Minimal hepatic encephalopathy was diagnosed in 15 (35.7%) patients. A total of 52.4% of patients showed significant extrapyramidal signs. Scores for the Columbia scale were higher in the presence of mHE (mean +/- SD, 16.0 +/- 10.9 vs 5.3 +/- 7.1, p = 0.0004). In the bivariate analysis, mHE, Child-Pugh score, and Mini-Mental State Examination score were significantly associated with extrapyramidal signs, whereas in the multivariate analysis, mHE was the only independent variable related to extrapyramidal signs.

CONCLUSIONS

There was a link between extrapyramidal signs and diagnosis of mHE based on manual neuropsychological testing. This finding may be explained by the influence of extrapyramidal manifestations on test performance or by a real pathophysiological relationship between both disorders. Further studies are necessary to resolve this question.

Authors+Show Affiliations

Service of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12873585

Citation

Jover, Rodrigo, et al. "Minimal Hepatic Encephalopathy and Extrapyramidal Signs in Patients With Cirrhosis." The American Journal of Gastroenterology, vol. 98, no. 7, 2003, pp. 1599-604.
Jover R, Compañy L, Gutiérrez A, et al. Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. Am J Gastroenterol. 2003;98(7):1599-604.
Jover, R., Compañy, L., Gutiérrez, A., Zapater, P., Pérez-Serra, J., Girona, E., Aparicio, J. R., & Pérez-Mateo, M. (2003). Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. The American Journal of Gastroenterology, 98(7), 1599-604.
Jover R, et al. Minimal Hepatic Encephalopathy and Extrapyramidal Signs in Patients With Cirrhosis. Am J Gastroenterol. 2003;98(7):1599-604. PubMed PMID: 12873585.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. AU - Jover,Rodrigo, AU - Compañy,Luís, AU - Gutiérrez,Ana, AU - Zapater,Pedro, AU - Pérez-Serra,Juan, AU - Girona,Eva, AU - Aparicio,José R, AU - Pérez-Mateo,Miguel, PY - 2003/7/23/pubmed PY - 2003/9/5/medline PY - 2003/7/23/entrez SP - 1599 EP - 604 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 98 IS - 7 N2 - OBJECTIVE: Two types of neurological dysfunction can occur in compensated cirrhosis: 1) extrapyramidal signs related to the accumulation of manganese in the basal ganglia and 2) milder degrees of cognitive impairment known as minimal hepatic encephalopathy (mHE). We assessed whether there was any relationship between both disorders in 42 patients with compensated cirrhosis. METHODS: Minimal hepatic encephalopathy was diagnosed using a battery of manual neuropsychological tests. Cognitive functioning was assessed by the Mini-Mental State Examination. Extrapyramidal signs were evaluated by the Columbia scale. RESULTS: Minimal hepatic encephalopathy was diagnosed in 15 (35.7%) patients. A total of 52.4% of patients showed significant extrapyramidal signs. Scores for the Columbia scale were higher in the presence of mHE (mean +/- SD, 16.0 +/- 10.9 vs 5.3 +/- 7.1, p = 0.0004). In the bivariate analysis, mHE, Child-Pugh score, and Mini-Mental State Examination score were significantly associated with extrapyramidal signs, whereas in the multivariate analysis, mHE was the only independent variable related to extrapyramidal signs. CONCLUSIONS: There was a link between extrapyramidal signs and diagnosis of mHE based on manual neuropsychological testing. This finding may be explained by the influence of extrapyramidal manifestations on test performance or by a real pathophysiological relationship between both disorders. Further studies are necessary to resolve this question. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/12873585/Minimal_hepatic_encephalopathy_and_extrapyramidal_signs_in_patients_with_cirrhosis_ L2 - http://Insights.ovid.com/pubmed?pmid=12873585 DB - PRIME DP - Unbound Medicine ER -