1. NEUROLOGIC COMPLICATIONS OF LIVER DISEASE Dr. ANAS JOUHAR

2. NEUROLOGIC COMPLICATIONS can be observed in patients with either acute or chronic liver Range from vogues symptoms ( fatigue ) to sever (coma )

3. Clinical features of hepatic Encephalopathy ( Cirrhosis ) Most characteristic symptoms extrapyramidal symptoms Neurological examination may disclose some hepatic failure before it disclose clinically.

5. Clinical course of HE Minimal HE : Slight attention deficits HE I : Psychomotor slowing HE II : Disorientation, bizarre, lethargy HE III : Somnolence – stupor HE IV : Coma

6. Other clinical feature of HE Rapid progress spastic paraplegia (hepatic mylopathy ) Progress parkinsonian syndromes (hepatolenticular degeneration ) Both of them due to portosystemic shunt

7. Acute Liver Failure Symptoms progress very fast Brain edema and seizure common in ALF Seizure seen in 45% of ALF Seizure due to plasma amonia levels > 120 mico mol/L

8. PATHOPHYSIOLOGY Ammonia has been considered as main toxin to development of HE Recent hypotheses focus on ammonia induced astrocyte swelling

9. THERAPY Aimed at the reduction of ammonia production and absorption in gut Nonabsorbable disaccharides and antibiotics Ornithineaspartate is used to support ammonia metabolism in muscle