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Metabolic Brain Disease
Published in: Metabolic Brain Disease 3-4/2007

01-12-2007 | Original Paper

Neuronal cell death in hepatic encephalopathy

Author: Roger F. Butterworth

Published in: Metabolic Brain Disease | Issue 3-4/2007

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Abstract

It is generally assumed that neuronal cell death is minimal in liver failure and is insufficient to account for the neuropsychiatric symptoms characteristic of hepatic encephalopathy. However, contrary to this assumption, neuronal cell damage and death are well documented in liver failure patients, taking the form of several distinct clinical entities namely acquired (non-Wilsonian) hepatocerebral degeneration, cirrhosis-related Parkinsonism, post-shunt myelopathy and cerebellar degeneration. In addition, there is evidence to suggest that liver failure contributes to the severity of neuronal loss in Wernicke’s encephalopathy. The long-standing nature of the thalamic and cerebellar lesions, over 80% of which are missed by routine clinical evaluation, together with the probability that they are nutritional in origin, underscores the need for careful nutritional management (adequate dietary protein, Vitamin B1) in liver failure patients. Mechanisms identified with the potential to cause neuronal cell death in liver failure include NMDA receptor-mediated excitotoxicity, lactic acidosis, oxidative/nitrosative stress and the presence of pro-inflammatory cytokines. The extent of neuronal damage in liver failure may be attenuated by compensatory mechanisms that include down-regulation of NMDA receptors, hypothermia and the presence of neuroprotective steroids such as allopregnanolone. These findings suggest that some of the purported “sequelae” of liver transplantation (gait ataxia, memory loss, confusion) could reflect preexisting neuropathology.
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Metadata
Title
Neuronal cell death in hepatic encephalopathy
Author
Roger F. Butterworth
Publication date
01-12-2007
Publisher
Springer US
Published in
Metabolic Brain Disease / Issue 3-4/2007
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI
https://doi.org/10.1007/s11011-007-9072-3

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