[Diagnosis and therapy of portosystemic encephalopathy]

With respect to the grade of disturbance of consciousness on one hand and concomitant cognitive, psychic and neuromuscular symptoms on the other hand several stages of portosystemic encephalopathy (PSE) are differentiated; moreover, it could recently be demonstrated that a remarkable proportion of cirrhotics without any clinical sign of cerebral dysfunction shows pathological results in psychometric and neurophysiological examinations. Therefore, the stage of subclinical, latent PSE was defined additionally. The assessment of subclinical PSE is usually done using paper-pencil tests or neurophysiological examinations like the EEG. The diagnosis of manifest PSE is made with respect to clinical criteria. Other possible causes of cerebral dysfunction have to be excluded by laboratory, neurological and eventually radiological examination. Therapy of PSE aims at the reduction production and resorption of ammonia. New therapeutic approaches, which have been proposed with regard to pathophysiological aspects of PSE other than ammonia, have not yet been established.