Torre DA, Guerrero-Hernández I, Uribe M

Idioma: Español
Referencias bibliográficas: 53
Paginas: 63-70
Archivo PDF: 84.68 Kb.

RESUMEN

El término encefalopatía hepática mínima (EHM) se refiere a los cambios sutiles en la función cognitiva, patrones electroencefalográficos, así como a las alteraciones a nivel de homeostasis de neurotransmisores cerebrales, flujo sanguíneo cerebral, metabolismo, y equilibrio de los fluidos plasmáticos que se observan en pacientes con cirrosis, aun cuando no exista una evidencia clínica de encefalopatía hepática. La prevalencia es tan alta como 84% de los pacientes con cirrosis hepática. Esta complicación de la cirrosis generalmente no es perceptible por el médico, y el diagnóstico sólo puede ser establecido mediante pruebas neuropsicológicas y mediciones especiales como potenciales evocados y estudios de imagen como la tomografía por emisión de positrones. El diagnóstico de encefalopatía hepática mínima pude tener implicaciones pronósticas y terapéuticas en pacientes cirróticos. La presente revisión pretende explorar los aspectos clínicos, terapéuticos, diagnósticos y pronósticos de esta complicación.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Quero JC, Schalm S. Subclinical hepatic encephalopathy. Semin Live Dis 1996; 16: 321-8.

2. Dhiman RH, Saraswat VA, Verma M, et al. Figure connection test: a universal test for assessment of mental state. J Gastroenterol Hepatol 1995; 10: 14-23.

3. Gitlin N, Lewis DC, Hinkley L. The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, nonshunted patients with cirrhosis. J Hepatol 1986; 3: 75-82.

4. Schomerus H, Hamster W. Quality of life in cirrhosis with minimal hepatic encephalopathy. Metab Brain Dis 2001; 16: 37-41.

5. Watanabe A. Cerebral changes in hepatic encephalopathy. J Gastroenterol Hepatol 1998; 13: 752-60.

6. Watanabe A, Tuchida T, Yata Y, et al. Evaluation of neuropsychological function in patients with liver cirrhosis with special reference to their driving ability. Metab Brain Dis 1995; 10: 239-48.

7. Das A, Dhiman RK, Saraswat VA, et al. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol 2001; 16: 531-5.

8. Córdoba J, Sanpedro F, Alonso J, et al. 1H magnetic resonance in the study of hepatic encephalopathy in humans. Metab Brain Dis 2002; 17: 415-29.

9. Ferenci P, Loockwood A, Mullen K, et al. Hepatic encephalopahty definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congress of Gastroenterology, Vienna 1998. Hepatology 2002; 35: 716-21.

10. Joebges EM, Heidemann M, Schimke N, et al. Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation. J Hepatol 2003; 38: 273-80.

11. Yang SS, Wu CH, Chiang TR, et al. Somatosensory evoked potentials in subclinical portosystemic encephalopathy: a comparison with psychometric tests. Hepatology 1998; 27: 357-61.

12. Ananya D, Radha KD, Vivek AS, et al. Prevalence and natural history of subclinical hepatic encephalopahty in cirrhosis. J of Gastroenterol Hepatol 2001; 16: 531-5.

13. Zeneroli M, Ciono G, Ventura P, et al. Interindividual variability of the number connection test. J Hepatol 1992; 16: 263-4.

14. Weissenborn K, Ruckert N, Hecker H, et al. The number connection test A and B interindividual variability and use for the assessment of early hepatic encephalopathy. J Hepatol 1998; 28: 646-53.

15. Conn HO. Trailmaking and number connection tests in the assessment of mental state in portal systemic encephalopathy. Am J Dig Dis 1977; 22: 541-50.

16. Weissenborn K, Ennen JC, Rückert N, et al. Neuropsychological characterization of hepatic encephaloapthy. J Hepatol 2001; 34: 768-73.

17. Amodio P, Marchett P, Del Piccolo F, et al. Study on the Sternberg paradigm in cirrhotic patients without hepatic encephalopathy. Metab Brain Dis 1998; 13: 159-72.

18. Kircheis G, Wettstein M, Timmermann L, et al. Critical flicker frequency for quantification of low grade hepatic encephalopathy: the diagnostic value of evoked potentials. J Hepatol 1995; 22: 101-10.

19. Kircheis G, Wettstein M, Timmermann L, et al. Critical flicker frequency for quantification of low grade hepatic encephalopathy. Hepatology 2002; 35: 357-66.

20. Niedermeyer E. Metabolic central nervous system disorders. In: Niedermeyer E, Lopes Da Silva F (eds.). Electroencephalography. Basis Priciples, Clinical Applications, and Related Fields, 4th ed. Baltimore: Williams and Wilkins; 1994, p. 416-31.

21. Kullmann F, Hollerbach S, Holstege A, et al. Subclinical hepatic encephalopathy: the diagnostic value of evoked potentials. J Hepatol 1995; 22: 101-10.

22. Amodio P, Marchetti P, Del Piccolo F, et al. Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol 1999; 110: 1334.

23. Amodio P, Del Piccolo F, Petteno E, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol 2001; 35: 37-45.

24. Menhdiratta MM, Sood GK, Sarin SK, et al. Comparative evaluation of visual, somatosensory, and auditory evoked potentials in the detection of subclinical hepatic encephalopathy in patients with nonalcoholic cirrhosis. Am J Gastroenterol 1990; 85: 799-803.

25. Suzuki C, Osaki I, Tanosaki M, et al. Peripheral and central conduction abnormalities in diabetes mellitus. Neurology 2000; 54: 1932-7.

26. Virtaniemi J, Kuusisto J, Karjalainen L, et al. Improvement of metabolic control does not normalize auditory brainstem latencies in subjects with insulin-dependent diabetes mellitus. Am J Otolaryngol 1995; 16: 172-6.

27. Saxena N, Bathia M, Joshi YK, et al. Auditory P300 event related potentials and number connection test for the diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis of liver. A follow up study. J Gastroenterol Hepatol 2001; 16: 322-7.

28. Jover R, Compañy L, Gutiérrez A, et al. Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. Am J Gastroenterol 2003; 98: 1599-604.

29. Ross BD, Danielsen ER, Blum S. Proton magnetic resonance spectroscopy: the new gold standard for diagnosis of clinical and subclinical hepatic encephalopathy? Dig Dis 1996; 14(Suppl 1): 30-9.

30. Ross BD, Jacobson S, Villamil F, et al. Subclinical hepatic encephalopathy: proton MR-specroscopic abnormalities: Radiology 1994; 193: 457-63.

31. Mechtcheriakov S, Shocke M, Kugener A, et al. Chemical shoft magnetic resonance spectroscopy of congulate grey matter in patients with minimal hepatic encephalopathy. Neuroradiology 2005; 47: 27-34.

32. Weissenborn K, Heidenreich S, Giewekemeyer K, et al. Memory function in early hepatic encephalopathy. J of Hepatol 2003; 39: 320-5.

33. Dam M, Burra P, Tedaschi U, et al. Regional cerebral blood flow changes in patients with cirrhosis assesses with 99mTc-HM-PAQ single photon emission computed tomography: effect of liver transplantation. J Hepatol 1998; 29: 78-84.

34. Catafau AM, Kuliesevsky J, Berná L, et al. Relationship between cerebral perfusion in frontal-limbic-basal ganglia circuits and neuropsychologic impairment in patients with subclinical hepatic encephalopathy. J Nucl Med 2000; 41: 405-10.

35. Posner MI. Petersen SE. The attention system of the human brain. Annu Rev Neurosci 1990; 13: 25-42.

36. Posner MI. Attention in cognitive neuroscience: an overview: the cognitive neuroscience. In: Gazzaniga MS (ed.). Cambridge Massachusetts: MIT press; 1995, p. 615-24.

37. Trzepacz PT, Tarter RE, Shah A, et al. SPECT scan and cognitive findigns in subclinical hepatic encephalopathy. J Neuropsychiatry Clin Neurosci 1994; 6: 170-5.

38. Lockwood AH, Murphy BW, Donnelly KZ, et al. Positron emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 1993; 18: 1061-8.

39. Groeneweg M, Quero JC, De Bruijin I, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 1998; 28: 45-9.

40. Ortiz M, Jacas C, Córdoba J. Minimal hepatic encephalopathy: diagnosis, clinical significance and recommendations. J Hepatol 2005; 42: S45-53.

41. Lockwood AH, Yap EW, Wong WH. Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 1991; 11: 337-41.

42. Cordoba J, Alonso J, Rovira A, et al. The development of low grade oedema in cirrhosis is supported by the evolution of (1) H-magnetic resonance abnormalities after liver transplantation. J Hepatol 2001; 35: 598-604.

43. Loockwood AH, Yap EW, Rhoades HM, et al. Altered cerebral blood floow and glucose metabolism in patients with liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 1991; 22: 331-6.

44. Riordan SM, Williams R. Treatment of hepatic encephalopathy. N Engl J Med 1997; 337: 473-9.

45. Jia L, Zhang MH. Comparison of probiotics and lactulose in the treatment of minimal hepatic encephalopathy in rats. World J Gastroenterol 2005; 11 (6); 908-911.

46. Solga SF. Probiotics can treat hepatic encephalopathy: Med Hypotheses 2003; 34: 768-73.

47. Liu Q, Ping Duan Z, Kang Ha S, et al. Synbiotic modulation of gut flora: Effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology 2004; 39: 1441-9.

48. de Bruijin KM, Blendis LM, Zilm DH, et al. Effect of dietary protein manipulation in subclinical portal-systemic encephalopathy. Gut 1983; 24: 53-60.

49. Egberts EH, Schomerus H, Hamster W, et al. Branched chain amino acids in the treatment of latent protosystemic encephalopathy. A double-blind placebo-controlled corssover study. Gastroenterology 1985; 88: 887-95.

50. Gooday R, Hayes PC, Bzeizi K, et al. Benzodiacepine receptor antagonism improves reaction time in latent hepatic encephalopathy. Psychopharmacology 1995; 119: 295-8.

51. Yen CL, Liaw YF. Somatosensory evoked potentials and number connection test in the detection of subclinical hepatic encephalopathy. Hepato-Gastroenterol 1990; 37: 332-4.

52. Romero-Gómez M, Grande L, Camacho I, et al. Altered response to oral glutamine challange as pornostic factor for overt episodes in patients with minimal hepatic encephalopathy. J Hepatol 2002; 37: 781-7.

53. Bustamante J, Rimola A, Ventura P, et al. Prognostic significance of hepatic encephalopathy in patients with cirrosis. J Hepatol 1999; 30: 890-95.