hepatic encephalopathy

Summary

Summary: A syndrome characterized by central nervous system dysfunction in association with LIVER FAILURE, including portal-systemic shunts. Clinical features include lethargy and CONFUSION (frequently progressing to COMA); ASTERIXIS; NYSTAGMUS, PATHOLOGIC; brisk oculovestibular reflexes; decorticate and decerebrate posturing; MUSCLE SPASTICITY; and bilateral extensor plantar reflexes (see REFLEX, BABINSKI). ELECTROENCEPHALOGRAPHY may demonstrate triphasic waves. (From Adams et al., Principles of Neurology, 6th ed, pp1117-20; Plum & Posner, Diagnosis of Stupor and Coma, 3rd ed, p222-5)

Top Publications

  1. Kappus M, Bajaj J. Covert hepatic encephalopathy: not as minimal as you might think. Clin Gastroenterol Hepatol. 2012;10:1208-19 pubmed publisher
    b>Hepatic encephalopathy (HE) is a serious neuropsychiatric and neurocognitive complication of acute and chronic liver disease...
  2. Ahboucha S, Talani G, Fanutza T, Sanna E, Biggio G, Gamrani H, et al. Reduced brain levels of DHEAS in hepatic coma patients: significance for increased GABAergic tone in hepatic encephalopathy. Neurochem Int. 2012;61:48-53 pubmed publisher
    ..ALLO), are candidates to explain the phenomenon of "increased GABAergic tone" in hepatic encephalopathy (HE)...
  3. Chavez Tapia N, Cesar Arce A, Barrientos Gutierrez T, Villegas López F, Mendez Sanchez N, Uribe M. A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy. Nutr J. 2013;12:74 pubmed publisher
    Because low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option...
  4. Gow A, Marques A, Yool D, Crawford K, Warman S, Eckersall P, et al. Dogs with congenital porto-systemic shunting (cPSS) and hepatic encephalopathy have higher serum concentrations of C-reactive protein than asymptomatic dogs with cPSS. Metab Brain Dis. 2012;27:227-9 pubmed publisher
    b>Hepatic encephalopathy (HE) is a cause of significant morbidity and mortality in patients with liver disorders and a wide range of rodent models of HE have been described to facilitate studies into the pathogenesis and treatment of HE...
  5. Romeiro F, da Silva Yamashiro F, Américo M, Corá L, Silva G, Miranda J, et al. Erythromycin versus neomycin in the treatment of hepatic encephalopathy in cirrhosis: a randomized double-blind study. BMC Gastroenterol. 2013;13:13 pubmed publisher
    b>Hepatic encephalopathy (HE) is a severe complication in patients with hepatic cirrhosis, which causes numerous hospital admissions and deaths...
  6. Lv X, Ye M, Han L, Zhang X, Cai P, Jiang G, et al. Abnormal baseline brain activity in patients with HBV-related cirrhosis without overt hepatic encephalopathy revealed by resting-state functional MRI. Metab Brain Dis. 2013;28:485-92 pubmed publisher
    ..of varying degrees is common in patients with hepatitis B virus-related cirrhosis (HBV-RC) without overt hepatic encephalopathy (OHE). However, the neurobiological mechanisms underlying these dysfunctions are not well understood...
  7. Bemeur C, Butterworth R. Liver-brain proinflammatory signalling in acute liver failure: role in the pathogenesis of hepatic encephalopathy and brain edema. Metab Brain Dis. 2013;28:145-50 pubmed publisher
  8. Agrawal A, Sharma B, Sharma P, Sarin S. Secondary prophylaxis of hepatic encephalopathy in cirrhosis: an open-label, randomized controlled trial of lactulose, probiotics, and no therapy. Am J Gastroenterol. 2012;107:1043-50 pubmed publisher
    Lactulose is effective in secondary prophylaxis of hepatic encephalopathy (HE). Probiotics improves minimal hepatic encephalopathy (MHE), which predisposes to HE...
  9. Jain L, Sharma B, Srivastava S, Puri S, Sharma P, Sarin S. Serum endotoxin, inflammatory mediators, and magnetic resonance spectroscopy before and after treatment in patients with minimal hepatic encephalopathy. J Gastroenterol Hepatol. 2013;28:1187-93 pubmed publisher
    Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy (HE), with abnormal neuropsychologic findings. Inflammatory response may be important in the pathogenesis of MHE...

More Information

Publications62

  1. Edwin N, Peter J, John G, Eapen C, Graham P. Relationship between clock and star drawing and the degree of hepatic encephalopathy. Postgrad Med J. 2011;87:605-11 pubmed publisher
    PURPOSE OF THE STUDY Current hepatic encephalopathy grading tools are limited because of complexity or subjectivity. The degree of constructional apraxia could serve as a simple, objective and reproducible tool to grade encephalopathy...
  2. Ni L, Qi R, Zhang L, Zhong J, Zheng G, Zhang Z, et al. Altered regional homogeneity in the development of minimal hepatic encephalopathy: a resting-state functional MRI study. PLoS ONE. 2012;7:e42016 pubmed publisher
    Little is known about how spontaneous brain activity progresses from non-hepatic encephalopathy (non-HE) to minimal HE (MHE)...
  3. Bajaj J, Hylemon P, Ridlon J, Heuman D, Daita K, White M, et al. Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation. Am J Physiol Gastrointest Liver Physiol. 2012;303:G675-85 pubmed publisher
    Although hepatic encephalopathy (HE) is linked to the gut microbiota, stool microbiome analysis has not found differences between HE and no-HE patients...
  4. Montoliu C, Gonzalez Escamilla G, Atienza M, Urios A, Gonzalez O, Wassel A, et al. Focal cortical damage parallels cognitive impairment in minimal hepatic encephalopathy. Neuroimage. 2012;61:1165-75 pubmed publisher
    Little attention has been paid to cortical integrity in patients with minimal hepatic encephalopathy (MHE), although cognitive functions affected in early stages of liver disease are mainly allocated in different neocortical structures...
  5. Montagnese S, Schiff S, De Rui M, Crossey M, Amodio P, Taylor Robinson S. Neuropsychological tools in hepatology: a survival guide for the clinician. J Viral Hepat. 2012;19:307-15 pubmed publisher
    ..i) to detect, grade and monitor liver failure-related cognitive alterations in end-stage liver disease (hepatic encephalopathy), (ii) to substantiate complaints of attention or concentration difficulties in patients with non-..
  6. Wang Q, Yin X, Duan Z, Guo S, Sun X. Role of the heme oxygenase/carbon monoxide pathway in the pathogenesis and prevention of hepatic encephalopathy. Mol Med Rep. 2013;8:67-74 pubmed publisher
    b>Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis and its pathogenesis has yet to be fully elucidated. Previous studies have demonstrated that heme oxygenase-1 (HO-1) is important in the induction of liver cirrhosis...
  7. Montagnese S, Schiff S, Turco M, Bonato C, Ridola L, Gatta A, et al. Simple tools for complex syndromes: a three-level difficulty test for hepatic encephalopathy. Dig Liver Dis. 2012;44:957-60 pubmed publisher
    Despite the impact of hepatic encephalopathy on quality of life and prognosis, easily administered tests for its diagnosis are still lacking...
  8. Butterworth R. Neuroinflammation in acute liver failure: mechanisms and novel therapeutic targets. Neurochem Int. 2011;59:830-6 pubmed publisher
    ..The neuroinflammatory response in ALF progresses in parallel with the progression of hepatic encephalopathy (HE) and with the severity of brain edema (astrocyte swelling)...
  9. Sharma P, Sharma B. Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. Saudi J Gastroenterol. 2012;18:168-72 pubmed publisher
    Minimal hepatic encephalopathy (MHE) is common in patients with extrahepatic portal vein obstruction (EHPVO). There is no study on the treatment of MHE using lactulose in patients with EHPVO...
  10. Dam G, Keiding S, Munk O, Ott P, Vilstrup H, Bak L, et al. Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake. Hepatology. 2013;57:258-65 pubmed publisher
    ..shown decreased cerebral oxygen metabolism (CMRO(2)) and blood flow (CBF) in patients with cirrhosis with hepatic encephalopathy (HE)...
  11. Bjerring P, Hauerberg J, Frederiksen H, Nielsen H, Clemmesen J, Larsen F. The effect of fractionated plasma separation and adsorption on cerebral amino acid metabolism and oxidative metabolism during acute liver failure. J Hepatol. 2012;57:774-9 pubmed publisher
    ..One single treatment session with FPSA had a marginal effect on plasma amino acid composition. We found minimal changes in the amino acids content in the microdialysate, and the lactate to pyruvate ratio was unaffected. ..
  12. Mattarozzi K, Cretella L, Guarino M, Stracciari A. Minimal hepatic encephalopathy: follow-up 10 years after successful liver transplantation. Transplantation. 2012;93:639-43 pubmed publisher
    ..effect of liver transplantation (LT) on cognitive functions and the complete reversibility of minimal hepatic encephalopathy are poorly documented...
  13. Goral V, Atayan Y, Kaplan A. The relation between pathogenesis of liver cirrhosis, hepatic encephalopathy and serum cytokine levels: what is the role of tumor necrosis factor ??. Hepatogastroenterology. 2011;58:943-8 pubmed
    b>Hepatic encephalopathy (HE) is a major complication of acute or chronic liver disease characterized by neuropsychiatric symptoms. It's etiology and pathogenetical mechanisms are not clearly understood and probably it is multifactorial...
  14. Chen H, Zhu X, Shu H, Yang M, Zhang Y, Ding J, et al. Structural and functional cerebral impairments in cirrhotic patients with a history of overt hepatic encephalopathy. Eur J Radiol. 2012;81:2463-9 pubmed publisher
    ..recent reports have revealed the persistence of cognitive impairment after clinical resolution of overt hepatic encephalopathy. We sought to explore the continued influence of overt hepatic encephalopathy on neurological function by ..
  15. Chen H, Zhu X, Jiao Y, Li P, Wang Y, Teng G. Abnormal baseline brain activity in low-grade hepatic encephalopathy: a resting-state fMRI study. J Neurol Sci. 2012;318:140-5 pubmed publisher
    ..alterations of spontaneous neuronal activity in various neuropsychiatric diseases, but rarely in low-grade hepatic encephalopathy (HE), a common neuropsychiatric complication of liver cirrhosis...
  16. McPhail M, Patel N, Taylor Robinson S. Brain imaging and hepatic encephalopathy. Clin Liver Dis. 2012;16:57-72 pubmed publisher
    Novel imaging techniques allow the investigation of structural and functional neuropathology of hepatic encephalopathy in greater detail, but limited techniques are applicable to the clinic...
  17. Coltart I, Tranah T, Shawcross D. Inflammation and hepatic encephalopathy. Arch Biochem Biophys. 2013;536:189-96 pubmed publisher
    b>Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with both acute and chronic liver dysfunction, spanning a spectrum that ranges from mild neuropsychological disturbances to coma...
  18. Qi R, Zhang L, Xu Q, Zhong J, Wu S, Zhang Z, et al. Selective impairments of resting-state networks in minimal hepatic encephalopathy. PLoS ONE. 2012;7:e37400 pubmed publisher
    Minimal hepatic encephalopathy (MHE) is a neuro-cognitive dysfunction characterized by impairment in attention, vigilance and integrative functions, while the sensorimotor function was often unaffected...
  19. Zhang L, Zheng G, Zhang L, Zhong J, Wu S, Qi R, et al. Altered brain functional connectivity in patients with cirrhosis and minimal hepatic encephalopathy: a functional MR imaging study. Radiology. 2012;265:528-36 pubmed publisher
    To investigate patterns of whole-brain functional connectivity in patients with minimal hepatic encephalopathy (HE) by using functional magnetic resonance (MR) imaging...
  20. Tao R, Zhang J, You Z, Wei L, Fan Y, Cui J, et al. The thalamus in cirrhotic patients with and without hepatic encephalopathy: a volumetric MRI study. Eur J Radiol. 2013;82:e715-20 pubmed publisher
    ..Some previous studies have suggested that the thalamus maybe implicated in the pathogenesis of hepatic encephalopathy. The aim of our study was to investigate changing thalamic volumes in cirrhotic patients with and without ..
  21. Bajaj J, Ridlon J, Hylemon P, Thacker L, Heuman D, Smith S, et al. Linkage of gut microbiome with cognition in hepatic encephalopathy. Am J Physiol Gastrointest Liver Physiol. 2012;302:G168-75 pubmed publisher
    b>Hepatic encephalopathy (HE) has been related to gut bacteria and inflammation in the setting of intestinal barrier dysfunction. We aimed to link the gut microbiome with cognition and inflammation in HE using a systems biology approach...
  22. Qi R, Zhang L, Zhong J, Zhang Z, Ni L, Jiao Q, et al. Altered effective connectivity network of the basal ganglia in low-grade hepatic encephalopathy: a resting-state fMRI study with Granger causality analysis. PLoS ONE. 2013;8:e53677 pubmed publisher
    The basal ganglia often show abnormal metabolism and intracranial hemodynamics in cirrhotic patients with hepatic encephalopathy (HE)...
  23. Qi R, Zhang L, Zhong J, Zhang Z, Ni L, Zheng G, et al. Disrupted thalamic resting-state functional connectivity in patients with minimal hepatic encephalopathy. Eur J Radiol. 2013;82:850-6 pubmed publisher
    Little is known about the role of thalamus in the pathophysiology of minimal hepatic encephalopathy (MHE)...
  24. Palomero Gallagher N, Zilles K. Neurotransmitter receptor alterations in hepatic encephalopathy: a review. Arch Biochem Biophys. 2013;536:109-21 pubmed publisher
    b>Hepatic encephalopathy (HE), a complex neuropsychiatric syndrome with symptoms ranging from subtle neuropsychiatric and motor disturbances to deep coma and death, is thought to be a clinical manifestation of a low-grade cerebral oedema ..
  25. Choi J, Kim Y, Roh S. Acute hepatic encephalopathy presenting as cortical laminar necrosis: case report. Korean J Radiol. 2013;14:324-8 pubmed publisher
    ..We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia. ..
  26. Kobashi Margáin R, Gavilanes Espinar J, Gutierrez Grobe Y, Gutiérrez Jiménez A, Chavez Tapia N, Ponciano Rodriguez G, et al. Albumin dialysis with molecular adsorbent recirculating system (MARS) for the treatment of hepatic encephalopathy in liver failure. Ann Hepatol. 2011;10 Suppl 2:S70-6 pubmed
    ..Up to 90% of the patients die waiting for an organ to be transplanted. Hepatic encephalopathy is a common neuropsychiatric syndrome that usually accompanies liver failure and impacts greatly on the ..
  27. Maldonado Garza H, Vazquez Elizondo G, Gaytán Torres J, Flores Rendón A, Cárdenas Sandoval M, Bosques Padilla F. Prevalence of minimal hepatic encephalopathy in cirrhotic patients. Ann Hepatol. 2011;10 Suppl 2:S40-4 pubmed
    Background. Minimal hepatic encephalopathy (MHE) has implications for health-related quality of life as well as for survival of cirrhotic patients, but a standardized diagnostic test is not available. Objective...
  28. Chen H, Zhu X, Yang M, Liu B, Zhang Y, Wang Y, et al. Changes in the regional homogeneity of resting-state brain activity in minimal hepatic encephalopathy. Neurosci Lett. 2012;507:5-9 pubmed publisher
    ..However, it is not known whether the ReHo is altered in cirrhotic patients with minimal hepatic encephalopathy (MHE). We recruited 18 healthy controls and 18 patients with MHE...
  29. Wunsch E, Szymanik B, Post M, Marlicz W, Mydłowska M, Milkiewicz P. Minimal hepatic encephalopathy does not impair health-related quality of life in patients with cirrhosis: a prospective study. Liver Int. 2011;31:980-4 pubmed publisher
    Minimal hepatic encephalopathy (HE) is a serious complication of cirrhosis; however, the impact of minimal HE on health-related quality of life (HRQoL) remains controversial...
  30. Peters L, Mocroft A, Soriano V, Rockstroh J, Rauch A, Karlsson A, et al. Hyaluronic acid levels predict risk of hepatic encephalopathy and liver-related death in HIV/viral hepatitis coinfected patients. PLoS ONE. 2013;8:e64283 pubmed publisher
    ..HA is an inexpensive, standardized and non-invasive supplement to other methods aimed at identifying HIV/viral hepatitis co-infected patients at risk of hepatic complications. ..
  31. Gorg B, Schliess F, Haussinger D. Osmotic and oxidative/nitrosative stress in ammonia toxicity and hepatic encephalopathy. Arch Biochem Biophys. 2013;536:158-63 pubmed publisher
    b>Hepatic encephalopathy (HE) is a neuropsychiatric complication of acute or chronic liver failure...
  32. Jayakumar A, Tong X, Curtis K, Ruiz Cordero R, Abreu M, Norenberg M. Increased toll-like receptor 4 in cerebral endothelial cells contributes to the astrocyte swelling and brain edema in acute hepatic encephalopathy. J Neurochem. 2014;128:890-903 pubmed publisher
    ..in intracranial pressure and brain herniation are major clinical consequences in patients with acute hepatic encephalopathy. We recently reported that conditioned media from brain endothelial cells (ECs) exposed to ammonia, a ..
  33. Desjardins P, Du T, Jiang W, Peng L, Butterworth R. Pathogenesis of hepatic encephalopathy and brain edema in acute liver failure: role of glutamine redefined. Neurochem Int. 2012;60:690-6 pubmed publisher
    ..While inhibitors of brain glutamine synthesis such as methionine sulfoximine, have been proposed for the prevention of brain edema in ALF, potential adverse effects have so far limited their applicability. ..
  34. Gundling F, Schmidtler F, Hapfelmeier A, Schulte B, Schmidt T, Pehl C, et al. Fecal calprotectin is a useful screening parameter for hepatic encephalopathy and spontaneous bacterial peritonitis in cirrhosis. Liver Int. 2011;31:1406-15 pubmed publisher
    ..translocation, causing intestinal inflammation, is one of the key mechanisms in the pathogenesis of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP) The presence of fecal calprotectin quantitatively relates ..
  35. Malaguarnera M, Vacante M, Motta M, Giordano M, Malaguarnera G, Bella R, et al. Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial. Metab Brain Dis. 2011;26:281-9 pubmed publisher
    ..this study was to investigate the effects of ALC treatment on cognitive functions in patients with severe hepatic encephalopathy. This was a randomized, double-blind, placebo-controlled study...
  36. Huang H, Chang C, Wang S, Chan C, Lee F, Chuang C, et al. Pravastatin for thioacetamide-induced hepatic failure and encephalopathy. Eur J Clin Invest. 2012;42:139-45 pubmed publisher
    ..Pravastatin ameliorates hepatic encephalopathy and liver biochemistry and improves survival in rats with acute liver failure, but not in those with ..
  37. Sharma P, Sharma B, Agrawal A, Sarin S. Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose. J Gastroenterol Hepatol. 2012;27:1329-35 pubmed publisher
    Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE...
  38. Qi R, Zhang L, Wu S, Zhong J, Zhang Z, Zhong Y, et al. Altered resting-state brain activity at functional MR imaging during the progression of hepatic encephalopathy. Radiology. 2012;264:187-95 pubmed publisher
    To explore the spatial patterns of the amplitude of low-frequency fluctuation (ALFF) in patients with hepatic encephalopathy (HE) of varying severity and to correlate these fluctuations with clinical markers of HE...
  39. Gorg B, Bidmon H, Haussinger D. Gene expression profiling in the cerebral cortex of patients with cirrhosis with and without hepatic encephalopathy. Hepatology. 2013;57:2436-47 pubmed publisher
    b>Hepatic encephalopathy (HE) is a frequent complication of liver cirrhosis and is seen as the clinical manifestation of a low-grade cerebral edema associated with oxidative-nitrosative stress...
  40. Malaguarnera M. Acetyl-L-carnitine in hepatic encephalopathy. Metab Brain Dis. 2013;28:193-9 pubmed publisher
    b>Hepatic encephalopathy is a common complication of hepatic cirrhosis. The clinical diagnosis is based on two concurrent types of symptoms: impaired mental status and impaired neuromotor function...
  41. Lin W, Hsu T, Chen C, Wu C, Lu C, Chen H, et al. Connectivity of default-mode network is associated with cerebral edema in hepatic encephalopathy. PLoS ONE. 2012;7:e36986 pubmed publisher
    Cerebral edema, a well-known feature of acute liver disease, can occur in cirrhotic patients regardless of hepatic encephalopathy (HE) and adversely affect prognosis...
  42. Sharma B, Sharma P, Lunia M, Srivastava S, Goyal R, Sarin S. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol. 2013;108:1458-63 pubmed publisher
    b>Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Drugs used in the treatment of HE are primarily directed at the reduction of the blood ammonia levels. Rifaximin and lactulose have shown to be effective in HE...
  43. Chen S, Wang L, Zhu Q, Cai J, Chen T, Si J. Effect of H pylori infection and its eradication on hyperammo-nemia and hepatic encephalopathy in cirrhotic patients. World J Gastroenterol. 2008;14:1914-8 pubmed
    To investigate the relationship between H pylori infection, blood ammonia concentration and hepatic encephalopathy (HE), and the effect of H pylori eradication in cirrhotic patients...
  44. Bajaj J, Etemadian A, Hafeezullah M, Saeian K. Testing for minimal hepatic encephalopathy in the United States: An AASLD survey. Hepatology. 2007;45:833-4 pubmed
  45. Dhiman R, Saraswat V, Sharma B, Sarin S, Chawla Y, Butterworth R, et al. Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for Study of the Liver. J Gastroenterol Hepatol. 2010;25:1029-41 pubmed publisher
    b>Hepatic encephalopathy (HE) is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Overt HE occurs in approximately 30-45% of cirrhotic patients...
  46. Romero Gomez M. Pharmacotherapy of hepatic encephalopathy in cirrhosis. Expert Opin Pharmacother. 2010;11:1317-27 pubmed publisher
    b>Hepatic encephalopathy (HE) is a major complication encountered in nearly half of the patients with liver cirrhosis...
  47. Chastre A, Jiang W, Desjardins P, Butterworth R. Ammonia and proinflammatory cytokines modify expression of genes coding for astrocytic proteins implicated in brain edema in acute liver failure. Metab Brain Dis. 2010;25:17-21 pubmed publisher
  48. Reddy P, Rama Rao K, Norenberg M. Inhibitors of the mitochondrial permeability transition reduce ammonia-induced cell swelling in cultured astrocytes. J Neurosci Res. 2009;87:2677-85 pubmed publisher
    Ammonia is the principal neurotoxin implicated in the pathogenesis of hepatic encephalopathy, and astrocytes are the neural cells predominantly affected in this condition...
  49. Singh S, Trigun S. Activation of neuronal nitric oxide synthase in cerebellum of chronic hepatic encephalopathy rats is associated with up-regulation of NADPH-producing pathway. Cerebellum. 2010;9:384-97 pubmed publisher
    Cerebellum-associated functions get affected during mild hepatic encephalopathy (MHE) in patients with chronic liver failure (CLF)...
  50. Hassanein T, Tofteng F, Brown R, McGuire B, Lynch P, Mehta R, et al. Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology. 2007;46:1853-62 pubmed
    Extracorporeal albumin dialysis (ECAD) may improve severe hepatic encephalopathy (HE) in patients with advanced cirrhosis via the removal of protein or non-protein-bound toxins...
  51. Garcia Martinez R, Rovira A, Alonso J, Jacas C, Simón Talero M, Chavarria L, et al. Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume. Liver Transpl. 2011;17:38-46 pubmed publisher
    b>Hepatic encephalopathy (HE) is a common complication of cirrhosis that is associated with brain atrophy and may participate in impaired cognitive function after liver transplantation...
  52. Barba I, Chatauret N, Garcia Dorado D, Cordoba J. A 1H nuclear magnetic resonance-based metabonomic approach for grading hepatic encephalopathy and monitoring the effects of therapeutic hypothermia in rats. Liver Int. 2008;28:1141-8 pubmed publisher
    There are no good biomarkers for grading hepatic encephalopathy (HE) and monitoring the effectiveness of therapeutic measures...
  53. Amodio P, Campagna F, Olianas S, Iannizzi P, Mapelli D, Penzo M, et al. Detection of minimal hepatic encephalopathy: normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study. J Hepatol. 2008;49:346-53 pubmed publisher
    Psychometric Hepatic Encephalopathy Score (PHES) and EEG are used to detect minimal hepatic encephalopathy (MHE)...