A Study on Pathophysiologyof CNS Manifestationsin Hepatic Encephalopathy

Abstract

Introduction: Hepatic insufficiency or portal-systemic shunting cause hepatic encephalopathy, which affects how well the central nervous system functions. HE causes a variety of neurologic symptoms to appear in connection with various liver conditions. The study aimed to analyze the pathophysiology of CNS manifestations of hepatic encephalopathy. Methods: This prospective study took place over the course of six months in the Department of Medicine at the Combined Military Hospital (CMH) in Dhaka, Bangladesh. 50 participants in all were included in this investigation. Result: Age distribution of the patients showed that 16% of the patients were 40 or less than 40 years old, 38% were 49-45 years old, 22% were 50-60 years old and 24% were more than 60 years old. The mean age was 50 (range: 29-69) years. A male preponderance was observed in the series with male to female ratio being 4:1. More than three-quarters (76%) of the patients were urban residents and the rest were rural residents. In terms of occupation, service-holder comprised 40% followed by business (26%), household work (24%), farming (8%), and laborer (2%).  A majority (94%) of the patients presented with overt hepatic encephalopathy and the rest had minimal hepatic encephalopathy. About two-thirds (66%) of the patients presented with a recurrent attack of hepatic encephalopathy, 28% with a secondary attack, and only 6% with a primary attack. History of the patients revealed that most of the patients were suffering from liver cirrhosis and encephalopathy began with sudden confusion of memory and disorientation about time, place, and person. The signs at presentation were loss of memory (70%), irritability (78%), asterixis 972%), and apraxia 976%). Sleep disturbance and excessive daytime sleepiness were also common (82% and 78% respectively). Personality changes were frequently common (92%) as reported by their caregivers. Of the extra-pyramidal dysfunctions, 50% had slowness of speech and 16% had hypokinesia. A few had rigidity (6%) and dyskinesia (2%). Conclusion:As a result of portal-systemic shunting or decreased hepatic clearance, hazardous chemicals like ammonia enter the systemic circulation in individuals with the liver illness and have negative effects (among other possibilities) on brain function. Once the harmful compounds have entered the neuronal tissue, several neurological alterations take place that has an impact on numerous neuronal circuits, each to a different degree. According to this study, personality alterations (92%), disorientation (86%), sleep disturbances (82%), irritability (78%), excessive daytime drowsiness (78%), apraxia (76%) asterixis (72%), and memory loss (72%) were the most common CNS signs (70 percent ).