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Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis
Rodrigo Jover1, Luís Compañy, Ana Gutiérrez
1Service of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.
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.
Insights
Neurological dysfunction in cirrhosis patients, specifically minimal hepatic encephalopathy (mHE) and extrapyramidal signs, are linked. mHE was independently associated with extrapyramidal signs in compensated cirrhosis patients.
Area of Science:
- Hepatology
- Neurology
- Neuropsychology
Background:
- Compensated cirrhosis can present with neurological issues like extrapyramidal signs and minimal hepatic encephalopathy (mHE).
- Extrapyramidal signs are linked to manganese accumulation in basal ganglia.
- mHE represents milder cognitive impairments in cirrhosis patients.
Purpose of the Study:
- To investigate the relationship between extrapyramidal signs and minimal hepatic encephalopathy (mHE) in patients with compensated cirrhosis.
Main Methods:
- Diagnosed mHE using manual neuropsychological tests.
- Assessed cognitive function with the Mini-Mental State Examination.
- Evaluated extrapyramidal signs using the Columbia scale in 42 compensated cirrhosis patients.
Main Results:
- Minimal hepatic encephalopathy (mHE) was diagnosed in 35.7% of patients.
- Significant extrapyramidal signs were observed in 52.4% of patients.
- mHE was the only independent variable associated with extrapyramidal signs in multivariate analysis (p=0.0004).
Conclusions:
- A significant link exists between extrapyramidal signs and mHE diagnosis in compensated cirrhosis.
- This association may stem from extrapyramidal symptoms affecting test performance or a shared pathophysiology.
- Further research is needed to elucidate the exact nature of this relationship.