Metabolic brain disease
-
Metabolic brain disease · Mar 2010
ReviewHyponatremic and hepatic encephalopathies: similarities, differences and coexistence.
Hyponatremic and hepatic encephalopathy are common causes of metabolic encephalopathy that may coexist in patients with cirrhosis. The clinical picture is common to any metabolic encephalopathy and is characterized by a confusional syndrome that may evolve into coma. Chronic mild or minimal manifestations can be seen in both, but motor symptoms are more common in hepatic encephalopathy. ⋯ Dysfunction of astrocytes, osmotic changes in the brain and brain edema are present in both situations. Recognition of these abnormalities is important to plan therapy. New drugs that affect brain hydration may be useful for both encephalopathies.
-
Metabolic brain disease · Mar 2009
ReviewThe brain in acute liver failure. A tortuous path from hyperammonemia to cerebral edema.
Acute liver failure (ALF) is a condition with an unfavourable prognosis. Multiorgan failure and circulatory collapse are frequent causes of death, but cerebral edema and intracranial hypertension (ICH) are also common complications with a high risk of fatal outcome. ⋯ This review will focus on the effects of hyperammonemia on neurotransmission, mitochondrial function, oxidative stress, inflammation and regulation of cerebral blood flow. Finally, potential therapeutic targets and future perspectives are briefly discussed.
-
Metabolic brain disease · Dec 2004
ReviewManagement of patients with fulminant hepatic failure and brain edema.
Cerebral edema in acute liver failure is associated with a poor prognosis. Optimization of cerebral perfusion pressure and blood flow plays a key role in contemporary management of these patients. However, understanding of the pathophysiology of brain edema is required for optimal patient management. This review explains the relationships between cerebral perfusion and edema and summarizes therapies that are currently used in patients with acute liver failure to prevent and reduce intracranial pressure.
-
Metabolic brain disease · Dec 2004
ReviewCerebral blood flow in acute liver failure: a finding in search of a mechanism.
In the last few years, several abnormalities of cerebral blood flow (CBF), namely loss of cerebral autoregulation, altered reactivity to carbon dioxide, and development of cerebral hyperemia, have been described in patients as well as experimental models of acute liver failure (ALF) and/or hyperammonemia. The development of cerebral hyperemia seems particularly relevant to the pathogenesis of brain edema in ALF. ⋯ In the rat after portacaval anastomosis receiving an ammonia infusion, the signal resulting in cerebral hyperemia arises within the brain once maximal glutamine accumulation has occurred in astrocytes. Several mediators potentially involved in the development of cerebral hyperemia in ALF are examined in this review, but further work is needed to assess the role, if any, of each of them.
-
The development of encephalopathy in patients with acute liver injury defines the occurrence of liver failure. The encephalopathy of acute liver failure is characterized by brain edema which manifests clinically as increased intracranial pressure. Despite the best available medical therapies a significant proportion of patients with acute liver failure die due to brain herniation. The present review explores the experimental and clinical data to define the role of hypothermia as a treatment modality for increased intracranial pressure in patients with acute liver failure.