41. Neuroimaging Aspects Of Chronic Acquired Hepatocerebral Degeneration In A Case R RD, Cole M. The acquired (nonwilsonian) type of chronic hepatocerebral degeneration.Medicine 1965; 44345-396. Lockwood AH. Hepatic encephalopathy and other http://med.ege.edu.tr/norolbil/2001/NBD16601.html

Journal of Neurological Sciences (Turkish) Table of Contents NOROL BIL D 18: 2 , 2001 http://www.med.ege.edu.tr/norolbil/2001/NBD16601.html Case Report NEUROIMAGING ASPECTS OF CHRONIC ACQUIRED HEPATOCEREBRAL DEGENERATION IN A CASE REPORT Melda BOZLUOLCAY , Zerrin PELIN , Hayrünissa DENKTAS Istanbul University Cerrahpasa School of Medicine, Department of Neurology, Istanbul , Turkey ABSTRACT Key-words: Chronic acquired hepatocerebral degeneration, magnetic resonance imaging, globus pallidus INTRODUCTION Research using both structural and functional neuroimaging techniques has been under way in an effort to find early markers of brain damage in patients with subclinical hepatic encephalopathy. Structural neuroimaging abnormalities, such as an increased T1-weighted MRI signal intensity in the globus pallidus has been described in cirrhotic patients without overt encephalopathy (4,5,6). These lesions have also been reported in the putamen as well as the mesencephalon in addition to the globus pallidus (7). Also the cerebral cortical and cerebellar atrophy are visualized abnormalities on the MR imaging (8). More recent advances in neuroimaging technology are beginning to reveal unique features in brain of patients with chronic liver failure. However there were very few studies reporting functional neuroimaging (i.e., PET or SPECT) findings (9,10) that may help to understand the nature of lesions in chronic liver disease. In this report, we will discuss the various clinical and radiological features including MR imaging PET and SPECT scan of the CAHD. A case that demonstrated the cognitive impairment and myoclonus was presented.

42. Final Diagnosis -- Case 221 Acquired hepatocerebral degeneration MR and pathologic findings. Exp Neurol 8 318346;Martinez A (1968) Electron microscopy in human hepatic encephalopathy. http://path.upmc.edu/cases/case221/dx.html

Final Diagnosis Acquired (Non-Wilsonian) hepatocerebral degeneration with "shunt myelopathy" FINAL DIAGNOSIS: Acquired (Non-Wilsonian) hepatocerebral degeneration with "shunt myelopathy" DISCUSSION: It is well known that patients with severe liver disease may suffer from a reversible neurologic condition known as hepatic encephalopathy [1,6]. Some of these patients suffer from a more permanent neurologic disorder, particularly if they have surgically induced or spontaneous porto-systemic shunts and experience episodes of severe hepatic encephalopathy with coma. Victor, Adams, et al. reported the features of AHCD in detail in a series of 27 cases [14]. These symptoms and signs included progressive dementia, dysarthria, involuntary movements (including tremor, asterixis, and choreoathetosis), ataxia of limb and gait, and mild pyramidal tract signs, typically in a patient with severe hepatic disease and recurrent episodes of coma. Less commonly reported is a progressive spastic myelopathy in association with AHCD [4,12]. Only about 15 cases have been reported in the world literature with detailed pathological descriptions [2,3,7,9,13]. The present case report has several distinctive features. Whereas most reported cases resulted from a surgically created porto-systemic shunt as a treatment for cirrhosis, a few other cases, including this one, are thought to result from spontaneously created shunts (e.g., varices) with the same functional consequences. The published cases usually had Alzheimer II cells in the brain, but only a few had the severe spongy degeneration in the deep cortex illustrated here. Recently, hepatocerebral degeneration has occasionally been documented in vivo by MRI [8,9]. Few electron microscopic studies of human Alzheimer II cells and hepatocerebral degeneration have been published [5,11]. The present report suggests that the vacuolation results from the disruption of astrocytes.

43. AJNR -- Flemming Et Al. 23 (8): 1421 MR imaging in patients with chronic hepatic encephalopathy shows symmetric This patterneven anticipates hepatocerebral disease, increases after portosystemic http://www.ajnr.org/cgi/content/full/23/8/1421

HOME HELP FEEDBACK SUBSCRIPTIONS ... TABLE OF CONTENTS QUICK SEARCH: [advanced] Author: Keyword(s): Year: Vol: Page: Abstract of this Article Figures Only for this Article PDF Version of this Article Citation Map Similar articles found in: AJNR Online PubMed PubMed Citation Search PubMed for articles by: Flemming, K. Jansen, O. Alert me when: new articles cite this article Download to Citation Manager American Journal of Neuroradiology 23:1421-1423, September 2002 American Society of Neuroradiology Case Report PEDIATRICS MR Spectroscopic Findings in a Case of Alpers-Huttenlocher Syndrome Katharina Flemming a Stefan Ulmer a Barbara Duisberg b Andreas Hahn b and Olav Jansen a a b Address reprint requests to Katharina Flemming, Herzog-Friedrich-Strasse 66, 24103 Kiel, Germany Abstract TOP Abstract Introduction Case Report Discussion Conclusion References Summary: Alpers-Huttenlocher syndrome, considered a mitochondrial disease, combines encephalopathy and liver failure. An 11-year-old boy with Alpers-Huttenlocher syndrome underwent conventional MR imaging, diffusion-weighted imaging, and proton MR spectroscopy.

44. Entrez PubMed MRI and MRS examine different aspects of hepatocerebral disease. Publication TypesReview; Review, Tutorial. MeSH Terms Hepatic encephalopathy/metabolism; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1

45. Entrez PubMed Ethanol neurotoxicity, Wernicke s encephalopathy, hepatocerebral degeneration, headtrauma, central pontine myelinolysis, MarchiafavaBignami syndrome, pellagra http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstra

46. Clinical Geriatrics Psychosis in dementia may occur in alcoholic dementia, or dementia associated withhepatic encephalopathy (chronic hepatocerebral degeneration) and Marchiafava http://www.mmhc.com/engine.pl?station=mmhc&template=cgfull.html&id=1984

47. EMR Textbook - The Alcoholic Patient: Neurological, Cardiac, Pulmonary, And Rena of thiamine or nicotinic acid, recurrent head trauma, hepatocerebral degeneration,and to cerebellar lesions seen in Wernicke’s encephalopathy suggests that http://www.hypertension-consult.com/Secure/textbookarticles/Textbook/154_alcohol

The Alcoholic Patient: Neurological, Cardiac, Pulmonary, and Renal Complications Rita K. Cydulka, MD, FACEP George Eversman, MD Alcohol . Few drugs wreak so much havoc so often and with such predictability. And to complicate matters, alcoholic patients are frequently uncooperative, have more than one underlying disease, and a compliance profile that is usually less than optimal. Critical diagnostic findings may be obscured by ethanol intoxication, and disposition decisions are complicated by the patient’s compromised capacity for vigilant self-care and appropriate follow-up. Add to these pitfalls the fact that chronic alcoholics tend to be poor historians and that the range of medical and surgical disorders afflicting them can fill a textbook of medicine, and it is clear why these patients are prone to falling between the diagnostic cracks. Although alcoholic patients are frequent users of emergency care, physician recognition of various alcohol-related diseases is poor. Some alcohol-related conditions require immediate lifesaving interventions, whereas others require hospital admission or outpatient referral for resolution. Whatever the diagnosis and ultimate disposition, recognition of chronic alcohol abuse as a cause for these problems is imperative so that early care can be instituted.

48. Hepatic Encephalopathy - 12 Articles - Part A In conclusion, MRI and MRS examine different aspects of hepatocerebral disease. 2S424.Related Articles, Links Minimal hepatic encephalopathy natural history http://archive.mail-list.com/hbv_research/msg06474.html

hbv_research archives Hepatic Encephalopathy - 12 articles - Part A Date: Wed, 24 Mar 2004 09:33:40 -0500 From hbv_research-list-owners@mail-list.com Subject Hepatic Encephalopathy - 12 articles - Part A mailto:HBV_Research-on@mail-list.com To unsubscribe, send a blank message to mailto:HBV_Research-off@mail-list.com To change your email address, send a message to mailto:HBV_Research-change@mail-list.com with your old address in the Subject: line Web Archive of all messages is at: http://archive.mail-list.com/hbv_research/ Prev by Date: Modulation of hepatitis B virus secretion by naturally occurring mutations in the S gene Next by Date: Hepatic Encephalopathy - 12 articles - Part B Return to Table of Contents:

49. Private Payers Serving Individuals With Disabilities And Chronic Conditions: App 571.6, Biliary cirrhosis, Yes, 572.2, Acute and chronic hepatic encephalopathy,acquired hepatocerebral degeneration, Yes, 576.1, Sclerosing cholangitis, Yes, http://aspe.hhs.gov/daltcp/reports/privpayA.htm

Private Payers Serving Individuals with Disabilities and Chronic Conditions Appendix A: Diagnosis Codes Associated with Potentially Disabling Conditions TABLE OF CONTENTS Table A-1 . Diagnosis Codes Associated with Potentially Disabling Physical Conditions among Adults Table A-2 . Diagnosis Codes Associated with Potentially Disabling Physical Conditions among Children Table A-3 . Diagnosis Codes Associated with Potentially Disabling Psychiatric Conditions among Adults Table A-4 . Diagnosis Codes Associated with Potentially Disabling Psychiatric Conditions among Children TABLE A-1 . Diagnosis Codes Associated with Potentially Disabling Physical Conditions among Adults ICD-9-CM Diagnosis Codes Condition Per Se Disabling? Activity-Limiting Condition? (LaPlante, 1989) Tuberculosis Yes AIDS Yes Severe neurosyphilis Yes Mental retardation Yes Chronic pulmonary coccidioidomycosis Yes Sarcoidosis Yes Post-polio syndrome Yes Malignant neoplasm of thymus Yes Malignant neoplasm of mediastinum Yes Malignant neoplasm of breast Malignant neoplasm of uterus, part unspecified

50. Handbook Of Medical Psychiatry, 2nd Edition 257.Hypocalcemia 258.Uremic encephalopathy 259.Dialysis Disequilibrium Syndrome 260.Hepaticencephalopathy and Acquired hepatocerebral Degeneration 261.Hepatic http://www.harcourt-international.com/catalogue/title.cfm?ISBN=0323029116

51. The Turkish Journal Of Gastroenterology some authors reported that the MRI findings of acquired hepatocerebral degenerationare Subclinical hepatic encephalopathy (SHE) has been reported in up to 84 http://www.turkgastro.org/text.php?id=4

52. Hepatonet Translate this page Improvement in chronic hepatocerebral degeneration following liver transplantation. Reversalof hepatic encephalopathy after occlusion of total portasystemic http://www.hepatonet.com/formacion/expertos3.php

Abril 2004 Diagnóstico de la colangitis esclerosante primaria Marzo 2004 Colangiografia por resonancia en las enfermedades hepatobiliares Febrero 2004 Diciembre 2003 Octubre 2003 Tratamiento de la hepatitis cronicas B Septiembre 2003 Mayo 2003 Mayo 2002 Abril 2002 Tratamiento de la hepatitis autoinmune Marzo 2002 Tratamiento de la ascitis refractaria Febrero 2002 Diciembre 2001 Noviembre 2001 Julio 2001 ... Junio 2001 Panel de Expertos Noviembre 2001 Hospital Universitario Vall d'Hebron Paseo Vall d'Hebron 119. Barcelona 08035. Tel: 34-93-2746140 Fax: 34-93-2746068 E-mail: jcordoba@hg.vhebron.es Dieta Subir Subir Subir Subir Dieta Subir Subir Subir Subir 1. Cordoba J, Blei AT. Treatment of hepatic encephalopathy. Am J Gastroenterol 1997; 92: 1429-39. 2. McMcrea M, Cordoba J, Vessey G, Blei AT, Randolph C. Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch Neurol 1996; 53: 758-63. 3. Adams RD, Foley JM. The neurological disorder associated with liver disease. Proc Ass Res Nerv Dis 1953; 32: 198-237.

53. Scope Of Work portalsystemic encephalopathy) Uremic encephalopathy encephalopathy associatedwith Chronic acquired (Non-Wilsonian) hepatocerebral degeneration Kernicterus http://www.cochraneneuronet.org/livello2/scope_of_work2.html

Index of Diseases BACK to scope of work ACQUIRED METABOLIC DISORDERS MIGRAINE AND HEADACHE ALCOHOL AND ALCOHOLISM ... OTHERS ACQUIRED METABOLIC DISORDERS back to index Ischemic-Hypoxic encephalopathy Carbon Monoxide Poisoning High-Altitude sickness Hypercapnic pulmonary disease Hypoglycemic encephalopathy Hyperglycemia Hepatic stupor and coma (hepatic or portal-systemic encephalopathy) Uremic encephalopathy Encephalopathy associated with sepsis and burns Disorders of sodium, potassium and water balance Central pontine myelinolysis Chronic acquired (Non-Wilsonian) hepatocerebral degeneration Kernicterus Hypoparathyroidism Cerebellar ataxia associated with myxedema Effects of Hyperthermia on the Cerebellum Cerebellar syndromes associated with celiac-sprue and Jejunoileal bypass Cushing disease and corticosteroid psychoses Thyroid encephalopathies Pancreatic encephalopathy

54. E. Management OF COMPLICATIONS OF CHRONIC LIVER DISEASE Patients with chronic encephalopathy should be advised against driving and E, PenderM, Chalk J. Improvement in chronic hepatocerebral degeneration following http://www.nzliver.org/Protocol/Finished/E Mgmt of Complications LTU Protocol.ht

E. Management OF COMPLICATIONS OF CHRONIC LIVER DISEASE BLEEDING COMPLICATING PORTAL HYPERTENSION Management of bleeding complicating portal hypertension Bleeding as a complication of portal hypertension can arise from the following sites: NB: 20-50% of episodes of upper GI bleeding in patients with cirrhosis are due to nonvariceal causes Patients may present in the following manner: All patients should be undergo oesophago-gastro-duodenoscopy (OGD) as per GI Bleeding Guidelines. In patients in whom variceal bleeding is suspected empirical treatment with Octreotide (see below) is recommended prior to diagnostic OGD. Management of suspected bleeding oesophageal varices: URGENT SCLEROTHERAPY/BANDING continued massive haematemesis encephalopathy suspected aspiration Proceed with oesophago-gastro-duodenoscopy (OGD) and carry out variceal band ligation/sclerotherapy If bleeding not controlled SSB tube (by experienced physician only) Increase PEEP Consider TIPPS If bleeding controlled repeat OGD in 24 hrs: IF uncertain that bleeding has been arrested.

55. ICP Monitors Related to Alcohol Induced Hepatic Disease. 1. Hepatic encephalopathy (hepatic coma). Notedto have elevated blood ammonia levels. 2. hepatocerebral Degeneration. http://www.ucch.org/sections/neurosurg/NeuroReview/10.2-Neurology/AlcoholCNS-PNS

Ethanol and its Effects on the Nervous System I. Intoxication Clinical Features excitement behavioural change slow learning decreased concentration decreased judgement confusion slurred speech incoordination blackouts (palimpsests) loss of airway protective reflexes depressed LOC respiratory depression associated with accidents (MVA), falls (SDH), anoxia, and death. II. Withdrawal State Clinical Features anxiety tremulousness hallucinations withdrawal seizures (rum fits) delirium tremens confusion, delusions, hallucinations, tremor, agitation death in 10% from cardiovasc collapse, hyperthermia, arrhythmia hypoglycemia keto-acidosis III. Nutritional Disorders 1. Wernicke Encephalopathy Clinical Features Nystagmus Conjugate gaze palsies (ophthalmoplegia) Gait ataxia Confusion Pathology 2. Korsakoff's Psychosis 3. Nutritional Polyneuropathy Pathology Axonal degeneration (secondary loss of myelin) Segmental demyelination Changes more severe distally IV. Diseases of Uncertain Etiology 1. Cerebellar Degeneration 2. Cerebral Atrophy 3. Central Pontine Myelinolysis 5. Deficiency Amblyopia (Tobacco-Alcohol)

56. Dr. Claudia Zwingmann - Curriculum Vitae International Symposium on hepatocerebral DISORDERS pathophysiology of cerebral 11thInternational Symposium on Hepatic encephalopathy and Nitrogen Metabolism http://www.chemie.uni-bremen.de/leibfritz/homepage/czcv.html

Curriculum Vitae personal data Name Zwingmann, Claudia date of birth and native town 19.04.1967, Bremen, Germany adress I: Centre de recherche du Centre Hospitalier de Universite de Montreal 1058, St.-Denis Street, H2X3J4 Montreal, Quebec, Canada Tel.: + 1/514/890-8310-35752 (Ext.) Fax. +1-514-412-7314 II: Department of Organic Chemistry (c/o Prof. Dr. D. Leibfritz) University of Bremen Leobener Strasse, 28359 Bremen,Germany Tel.: +11-49-421-2183865 Fax: +11-40-421-2184264 e-Mail czwingmann@web.de education primary- and orientation school, Worpswede, Germany secondary school Osterholz-Scharmbeck, Germany vocational training to office worker Autohaus Fritz Burr, Bremen, Germany working office worker, Automobile Knobloch, Osterholz-Scharmbeck, Germany 05-08/1988 stewardess "MS Berlin" Bergolin, Ritterhude, Germany referee at the staw department and book-keeping Jacobs Suchard, Bremen, Germany continuation schools course to referee for controlling/accountancy, Hamburg college for secretary, IHK exam, Stade aptitude test to an instructor ("AEVO"), IHK, Stade academics examination to admission for the study at german Universities at the University of Oldenburg, Germany

57. Case Studies and relate closely to the pathogenesis of hepatic encephalopathy and protein oftherapeutic tools applied in patients with the hepatocerebral syndrome is http://www.atozofhealth.com/Amino Acids/case_studies.htm

A t o Z of Health Dedicated to Making You Healthier A to Z of Health Biographies General Medicine Cancer ... Search Page Case Studies Oral supplementation with branched-chain amino acids improves transthyretin turnover in rats with carbon tetrachloride-induced liver cirrhosis Journal of Nutrition (USA), 1996, 126/5 (1412-1420) Overview of randomized clinical trials of oral branched-chain amino acid treatment in chronic hepatic encephalopathy Journal of Parenteral and Enteral Nutrition (USA), 1996, 20/2 (159-164) Leucine metabolism in rats with cirrhosis. J Hepatol (DENMARK) Feb 1996, 24 (2) p209-16 Nutrient-induced thermogenesis and protein-sparing effect by rapid infusion of a branched chain-enriched amino acid solution to cirrhotic patients. J Med (UNITED STATES) 1996, 27 (3-4) p176-82 An increase in the resting energy expenditure (REE) on indirect calorimetry was observed by rapid intravenous infusion of a branched chain-enriched amino acid solution into cirrhotic patients. The increases resulted in nutrient-induced thermogenesis (NIT). The percentage of energy expenditure (EE) derived from protein decreased significantly with the infusion of the amino acids. The present pilot study demonstrates that branched chain amino acids can be utilized as energy substrates and a protein-sparing effect occurs in patients with liver cirrhosis. Effect of branched chain amino acid infusions on body protein metabolism in cirrhosis of liver.

58. CNSforum and common subset of acquired hepatocerebral degeneration, whose features are permanentand entirely different from acute hepatic encephalopathy episodes. http://www.cnsforum.com/cp/en/CNSforum/literature/abstracts_otm/neurology/may200

59. Selecciones Veterinarias Virtual - Bibliografía W, Hickey WF, Dobson W E. Early childhood hepatocerebral degeneration misdiagnosed ofAlpers disease (cronic progressive encephalopathy) produces experimental http://www.seleccionesveterinarias.com/Bibliografia.html

60. Arquivos De Neuro-Psiquiatria - Translate this page M. The acquired (non Wilsonian) type of chronic hepatocerebral degeneration. in livercirrhosis patients with chronic persistent encephalopathy evaluation by http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X1999000200024&l

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