Visual and auditory evoked responses in acute severe hepatitis

Area of Science:

• Neuroscience
• Hepatology
• Clinical Electrophysiology

Background:

• Evoked responses, including visual evoked responses (VER) and brain stem auditory evoked responses (BAER), have not been extensively studied in acute severe hepatitis (ASH).
• Understanding the diagnostic and prognostic utility of these neurophysiological tests in ASH, particularly with hepatic encephalopathy, is crucial.

Purpose of the Study:

• To investigate the diagnostic and prognostic value of VER and BAER in patients with ASH.
• To compare evoked response abnormalities between ASH patients with and without encephalopathy.

Main Methods:

• Prospective study of 20 ASH patients, divided into ASH without encephalopathy (ASH-WOE) and ASH with encephalopathy (fulminant hepatic failure, FHF) groups.
• Neuropsychiatric examination, VER, and BAER assessments were performed.
• Evoked responses were reassessed in survivors after 2-3 weeks.

Main Results:

• Significantly prolonged median P100 latencies in FHF patients compared to controls and ASH-WOE patients.
• Abnormal P100 latencies were found in 1/10 ASH-WOE and 6/10 FHF patients.
• Prolonged interpeak latencies (I-III, III-V, I-V) were observed in FHF patients, and III-V in ASH-WOE patients.
• VER abnormalities were predominantly seen in the FHF group, while BAER abnormalities occurred in both.
• In FHF survivors, VER abnormalities tended to normalize, indicating prognostic potential.

Conclusions:

• VER abnormalities are more frequent and pronounced in FHF, suggesting significant neurological involvement.
• VER and BAER hold diagnostic and prognostic value in ASH, especially in differentiating severity and predicting outcomes.
• Markedly prolonged P100 latencies in FHF patients correlate with a poor prognosis.