About Minimal Hepatic Encephalopathy

Abstract

Introduction. Hepatic encephalopathy comprises a broad spectrum of neuropsychiatric manifestations, commonly encountered in patients with hepatic dysfunction, in the absence of other concomitant causes of cerebral infarction. Under these conditions, varying degrees of consciousness, neuromuscular dysfunction, cognitive, behavioral and emotional deficits coexist. Minimal hepatic encephalopathy (MHE) is defined by a normal neurological clinical examination but with cognitive deficits that can be highlighted by neuropsychological testing.

Material and Methods. A retrospective study was conducted on the latest 100 patients (2016-2018), traumatized in road accidents or dropping from their own level, the direct causes of which were apparently inexplicable. The methods included psychometric tests.

Results and Discussion. If 78 patients were known with hepatic cirrhosis and episodically manifested encephalopathy, 20 of them were in treatment for major liver dysfunction, but without encephalopathy, and for 2 patients, the revealing element of hepatic suffering was latent encephalopathy, diagnosed after the road accident. The paper discusses the pathogenesis of hepatic encephalopathy, diagnostic difficulties and its practical implications.

Conclusions. The current gold standard for MHE diagnosis is psychometric testing, which should be completed and revised as MHE is a major public health issue, associating with the risk of unprovoked falls and road accidents. MHE detection, sometimes as the first sign of decompensation of an ignored liver disease, but always as a prodrome of clinically manifest encephalopathy, requires specialized treatment and monitoring.