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Reversible periodic alternating gaze deviation in hepatic encephalopathy
1Department of Neurology, Hadassah University Hospital, Jerusalem, Israel.
Neurology
|January 1, 1995
Summary
Hepatic encephalopathy can cause periodic alternating gaze deviation (PAGD), a rare eye movement disorder. This condition resolved in two patients after treating their underlying liver dysfunction, suggesting a reversible neurological link.
Area of Science:
- Neurology
- Gastroenterology
- Ophthalmology
Background:
- Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver dysfunction.
- Periodic alternating gaze deviation (PAGD) is an abnormal eye movement characterized by conjugate deviation of the eyes to one side, alternating at regular intervals.
Observation:
- Two patients with hepatic encephalopathy presented with newly developed PAGD.
- No structural brain lesions were identified as the cause of the PAGD in either patient.
Findings:
- The PAGD resolved in both patients following successful treatment of their hepatic encephalopathy.
- A GABA-mediated dysfunction in the cerebellar nodulus and uvula is hypothesized as the underlying mechanism for PAGD in HE.
Implications:
- This suggests that PAGD in the context of HE may be a reversible sign of neurological dysfunction.
- Highlights the importance of considering and treating HE in patients presenting with unexplained PAGD.
- Further research into the neurochemical pathways, particularly GABAergic signaling, in HE-associated eye movement disorders is warranted.