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Minimal encephalopathy

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https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#1
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29023586/reduced-resting-state-connectivity-and-gray-matter-volume-correlate-with-cognitive-impairment-in-minimal-hepatic-encephalopathy
#2
Raquel García-García, Álvaro Javier Cruz-Gómez, Alba Mangas-Losada, Amparo Urios, Cristina Forn, Desamparados Escudero-García, Elena Kosenko, Juan Fermín Ordoño, Joan Tosca, Remedios Giner-Durán, Miguel Angel Serra, César Avila, Vicente Belloch, Vicente Felipo, Carmina Montoliu
BACKGROUND AND AIMS: Minimal hepatic encephalopathy (MHE) is associated with cognitive alterations and changes in connectivity. We assessed the relationship of the abnormalities of resting-state functional connectivity (rs-FC) and gray matter (GM) volume with different cognitive alterations and biochemical parameters associated to MHE. METHODS: Thirty-nine cirrhotic patients (26 without and 13 with MHE) and 24 controls were widely cognitive assessed with a battery of psychometric tests...
2017: PloS One
https://www.readbyqxmd.com/read/29020023/the-continuous-reaction-time-test-for-minimal-hepatic-encephalopathy-validated-by-a-randomized-controlled-multi-modal-intervention-a-pilot-study
#3
M M Lauridsen, S Mikkelsen, T Svensson, J Holm, C Klüver, J Gram, H Vilstrup, O B Schaffalitzky de Muckadell
BACKGROUND: Minimal hepatic encephalopathy (MHE) is clinically undetectable and the diagnosis requires psychometric tests. However, a lack of clarity exists as to whether the tests are in fact able to detect changes in cognition. AIM: To examine if the continuous reaction time test (CRT) can detect changes in cognition with anti-HE intervention in patients with cirrhosis and without clinically manifest hepatic encephalopathy (HE). METHODS: Firstly, we conducted a reproducibility analysis and secondly measured change in CRT induced by anti-HE treatment in a randomized controlled pilot study: We stratified 44 patients with liver cirrhosis and without clinically manifest HE according to a normal (n = 22) or abnormal (n = 22) CRT...
2017: PloS One
https://www.readbyqxmd.com/read/28974999/malignant-posterior-reversible-encephalopathy-syndrome-an-exacting-challenge-for-neurocritical-care-physicians
#4
Shahvaiz Magsi, Atif Zafar
We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28965835/dopamine-induces-glutamate-accumulation-in-astrocytes-to-disrupt-neuronal-function-leading-to-pathogenesis-of-minimal-hepatic-encephalopathy
#5
Saidan Ding, Xuebao Wang, Weishan Zhuge, Jianjing Yang, Qichuan Zhuge
Minimal hepatic encephalopathy (MHE) is induced by elevated intracranial dopamine (DA). Glutamate (Glu) toxicity is known to be involved in many neurological disorders. In this study, we investigated whether DA increased Glu levels and collaborated with Glu to impair memory. We found that DA upregulated TAAR1, leading to reduced EAAT2 expression and Glu clearance in primary cortical astrocytes (PCAs). High DA increased TAAR1 expression, and high Glu increased AMPAR expression, inducing the activation of CaN/NFAT signaling and a decrease in the production of BDNF (Brain Derived Nerve Growth Factor)/NT3 (neurotrophin-3) in primary cortical neurons (PCNs)...
September 29, 2017: Neuroscience
https://www.readbyqxmd.com/read/28953991/candesartan-rather-than-losartan-improves-motor-dysfunction-in-thioacetamide-induced-chronic-liver-failure-in-rats
#6
H A Murad, Z J Gazzaz, S S Ali, M S Ibraheem
Minimal hepatic encephalopathy is more common than the acute syndrome. Losartan, the first angiotensin-II receptor blocker (ARB), and candesartan, another widely-used ARB, have protected against developing fibrogenesis, but there is no clear data about their curative antifibrotic effects. The current study was designed to examine their effects in an already-established model of hepatic fibrosis and also their effects on the associated motor dysfunction. Low-grade chronic liver failure (CLF) was induced in 3-month old Sprague-Dawley male rats using thioacetamide (TAA, 50 mg·kg-1·day-1) intraperitoneally for 2 weeks...
September 21, 2017: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/28932186/da-negatively-regulates-igf-i-actions-implicated-in-cognitive-function-via-interaction-of-psd95-and-nnos-in-minimal-hepatic-encephalopathy
#7
Saidan Ding, Weishan Zhuge, Xuebao Wang, Jianjing Yang, Yuanshao Lin, Chengde Wang, Jiangnan Hu, Qichuan Zhuge
Insulin-like growth factor I (IGF-I) has been positively correlated with cognitive ability. Cognitive decline in minimal hepatic encephalopathy (MHE) was shown to be induced by elevated intracranial dopamine (DA). The beneficial effect of IGF-I signaling in MHE remains unknown. In this study, we found that IGF-I content was reduced in MHE rats and that IGF-I administration mitigated cognitive decline of MHE rats. A protective effect of IGF-I on the DA-induced interaction between postsynaptic density protein 95 (PSD95) and neuronal nitric oxide synthase (nNOS) was found in neurons...
2017: Frontiers in Cellular Neuroscience
https://www.readbyqxmd.com/read/28926420/seronegative-paraneoplastic-limbic-encephalitis-associated-with-thymoma
#8
Jaime Toro, David Cuellar-Giraldo, Alejandra Duque, Karla Minota, Jorge Patiño, Manuel García
Paraneoplastic limbic encephalitis is an autoimmune syndrome characterized by the acute or subacute onset of encephalopathy, memory loss, confusion, temporal lobe seizures, and behavioral and mood changes. Although most patients with paraneoplastic limbic encephalitis have antineuronal antibodies, advances in the field now permit the diagnosis without autoantibody test results. In this case illustrating the new diagnostic criteria, we report a 70-year-old woman who was brought to the emergency room after the acute onset of cognitive impairment, altered mental status, and choreoathetoid movements...
September 2017: Cognitive and Behavioral Neurology: Official Journal of the Society for Behavioral and Cognitive Neurology
https://www.readbyqxmd.com/read/28925994/chimeric-antigen-receptor-t-cell-therapy-assessment-and-management-of-toxicities
#9
REVIEW
Sattva S Neelapu, Sudhakar Tummala, Partow Kebriaei, William Wierda, Cristina Gutierrez, Frederick L Locke, Krishna V Komanduri, Yi Lin, Nitin Jain, Naval Daver, Jason Westin, Alison M Gulbis, Monica E Loghin, John F de Groot, Sherry Adkins, Suzanne E Davis, Katayoun Rezvani, Patrick Hwu, Elizabeth J Shpall
Immunotherapy using T cells genetically engineered to express a chimeric antigen receptor (CAR) is rapidly emerging as a promising new treatment for haematological and non-haematological malignancies. CAR-T-cell therapy can induce rapid and durable clinical responses, but is associated with unique acute toxicities, which can be severe or even fatal. Cytokine-release syndrome (CRS), the most commonly observed toxicity, can range in severity from low-grade constitutional symptoms to a high-grade syndrome associated with life-threatening multiorgan dysfunction; rarely, severe CRS can evolve into fulminant haemophagocytic lymphohistiocytosis (HLH)...
September 19, 2017: Nature Reviews. Clinical Oncology
https://www.readbyqxmd.com/read/28919805/a-pilot-evaluation-of-a-computer-based-psychometric-test-battery-designed-to-detect-impairment-in-patients-with-cirrhosis
#10
Nicola A Cook, Jin Un Kim, Yasmin Pasha, Mary Me Crossey, Adrian J Schembri, Brian T Harel, Torben Kimhofer, Simon D Taylor-Robinson
BACKGROUND: Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients' quality of life and the ability to drive and operate machinery (with societal consequences). AIM: We compared the Cogstate™ computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28912616/decision-making-in-neonatal-end-of-life-scenarios-in-low-income-settings-1
#11
James McTavish
The challenge of decision making in end-of-life scenarios is exacerbated when the patient is a newborn and in a low-income setting. The principle of proportionate care is a helpful guide but needs to be applied. The complex interplay of benefit, burden, and cost of various treatments all need to be considered. In patients with severe neonatal encephalopathy, prognosis can be hard to determine, and a team approach to decision making can help. In low-income settings, or where there are limited resources, the ideal care needs to be incarnated in the real context...
August 2017: Linacre Quarterly
https://www.readbyqxmd.com/read/28912425/predictive-models-of-minimal-hepatic-encephalopathy-for-cirrhotic-patients-based-on-large-scale-brain-intrinsic-connectivity-networks
#12
Yun Jiao, Xun-Heng Wang, Rong Chen, Tian-Yu Tang, Xi-Qi Zhu, Gao-Jun Teng
We aimed to find the most representative connectivity patterns for minimal hepatic encephalopathy (MHE) using large-scale intrinsic connectivity networks (ICNs) and machine learning methods. Resting-state fMRI was administered to 33 cirrhotic patients with MHE and 43 cirrhotic patients without MHE (NMHE). The connectivity maps of 20 ICNs for each participant were obtained by dual regression. A Bayesian machine learning technique, called Graphical Model-based Multivariate Analysis, was applied to determine ICN regions that characterized group differences...
September 14, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28888081/study-of-the-sleep-quality-and-psychological-state-of-patients-with-hepatitis-b-liver-cirrhosis
#13
Guoqing Xiao, Qing Ye, Tao Han, Junqing Yan, Lixia Sun, Fengmei Wang
We aimed to investigate the sleep quality, mild hepatic encephalopathy, anxiety and depression in patients with hepatitis B cirrhosis by using a variety of scales and questionnaires. A cohort of 341 patients with hepatitis B liver cirrhosis were categorized by Child-Pugh grading (A, B, and C) in this cross-sectional study. Pittsburgh Sleep Quality Index (PSQI), Number Connection Test-A (NCT-A), and Hospital Anxiety and Depression (HAD) evaluated the questionnaires and statistically analyzed the intrinsic correlation...
September 9, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28886982/management-of-epilepsy-due-to-hypothalamic-hamartomas
#14
REVIEW
Ayaz M Khawaja, Sandipan Pati, Yu-Tze Ng
A hypothalamic hamartoma consists of hyperplastic heterotopic tissue growing in a disorganized fashion. These lesions occur in about one per 50,000 to 100,000 people. Hypothalamic hamartomas can cause intrinsic epileptogenesis leading to gelastic seizures. Surrounding cortical structures may also develop secondary epileptogenesis. Persistent seizures caused by hypothalamic hamartomas can be debilitating and result in significant cognitive and behavioral impairment. Early recognition and treatment is important in controlling seizures and in preventing further cognitive deterioration...
July 5, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28861407/alterations-in-cerebral-blood-flow-after-resuscitation-from-cardiac-arrest
#15
REVIEW
Bistra Iordanova, Lingjue Li, Robert S B Clark, Mioara D Manole
Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF) is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28840059/dopamine-burden-induced-the-inactivation-of-sonic-hedgehog-signaling-to-cognitive-decline-in-minimal-hepatic-encephalopathy
#16
Saidan Ding, Jianjing Yang, Xueli Huang, Leping Liu, Jiangnan Hu, Zhu Xu, Qichuan Zhuge
Minimal hepatic encephalopathy (MHE) is induced by elevated intracranial dopamine (DA). The relationship of the Shh pathway with memory loss in MHE, however, is elusive. In the current study, rats with MHE induced with DA displayed downregulation of the Shh pathway. Additionally, injection of Shh into MHE/DA-treated rats reversed downregulation of BDNF/NT3, whereas administration of cyclopamine (Cyc) enhanced the inhibition of expression of BDNF/NT3. Furthermore, naringin (Nrg) substantially prevented cognitive impairment in MHE/DA-treated rats and upregulated the Shh pathway, paralleling the elevated expression of BDNF/NT3...
July 2017: Aging and Disease
https://www.readbyqxmd.com/read/28838925/case-of-steroid-responsive-encephalopathy-from-hypoglycaemia
#17
Jay L Mathur, Fereshteh Rajabi, Allison Schroeder, Torben K Becker
Hypoglycaemic encephalopathy is a feared complication in the management of patients with diabetes mellitus. We report on a 73-year-old woman with type 1 diabetes managed with an insulin pump who presented unresponsive after an inappropriate insulin bolus. The patient had minimal improvement in her neurological status over 8 days. After administration of 1 g intravenous methylprednisolone, she had dramatic neurological improvement including successful extubation and discharge from the intensive care unit...
August 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28805273/neurotoxicosis-in-horses-associated-with-consumption-of-trema-micrantha
#18
M P Lorenzett, P R Pereira, D M Bassuino, G Konradt, W Panziera, M V Bianchi, F F Argenta, M E Hammerschmitt, R A Caprioli, C S L de Barros, S P Pavarini, D Driemeier
BACKGROUND: Trema micrantha is a tree widely distributed throughout the Americas. The tree produces highly palatable leaves that have been associated with natural poisoning in goats, sheep and horses, in which hepatic necrosis and hepatic encephalopathy have been observed. OBJECTIVES: This study describes malacia and haemorrhage in the central nervous system (CNS) due to T. micrantha consumption, with minimal to absent hepatic lesions. STUDY DESIGN: Retrospective case series...
August 14, 2017: Equine Veterinary Journal
https://www.readbyqxmd.com/read/28796283/flumazenil-versus-placebo-or-no-intervention-for-people-with-cirrhosis-and-hepatic-encephalopathy
#19
REVIEW
Ee Teng Goh, Mette L Andersen, Marsha Y Morgan, Lise Lotte Gluud
BACKGROUND: Hepatic encephalopathy is a common complication of cirrhosis which results in poor brain functioning. The spectrum of changes associated with hepatic encephalopathy ranges from the clinically 'indiscernible' or minimal hepatic encephalopathy to the clinically 'obvious' or overt hepatic encephalopathy. Flumazenil is a synthetic benzodiazepine antagonist with high affinity for the central benzodiazepine recognition site. Flumazenil may benefit people with hepatic encephalopathy through an indirect negative allosteric modulatory effect on gamma-aminobutyric acid receptor function...
August 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28776344/validation-of-a-paper-and-pencil-test-battery-for-the-diagnosis-of-minimal-hepatic-encephalopathy-in-korea
#20
Jae Yoon Jeong, Dae Won Jun, Daiseg Bai, Ji Yean Kim, Joo Hyun Sohn, Sang Bong Ahn, Sang Gyune Kim, Tae Yeob Kim, Hyoung Su Kim, Soung Won Jeong, Yong Kyun Cho, Do Seon Song, Hee Yeon Kim, Young Kul Jung, Eileen L Yoon
The aim of this study was to validate a new paper and pencil test battery to diagnose minimal hepatic encephalopathy (MHE) in Korea. A new paper and pencil test battery was composed of number connection test-A (NCT-A), number connection test-B (NCT-B), digit span test (DST), and symbol digit modality test (SDMT). The norm of the new test was based on 315 healthy individuals between the ages of 20 and 70 years old. Another 63 healthy subjects (n = 31) and cirrhosis patients (n = 32) were included as a validation cohort...
September 2017: Journal of Korean Medical Science
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