Features of encephalopathy diagnosis in patients with portal hypertension syndrome

Yu.M. Stepanov, N.V. Chaliy, S.L. Меlanich


Background. Hepatic encephalopathy is a pathological change in the brain functions of non-inflammatory origin, which is manifested by a syndrome of secondary neurological and cognitive disorders caused by a set of deep metabolic disorders, as a result of acute hepatic insufficiency, chronic liver disease or portosystemic shunting of the blood. The initial stage of encephalopathy does not have clinical neurologic symptoms, but is defined in 20–80 % of patients with liver cirrhosis, and, unlike the final stages, is reversible. The purpose of the study was to evaluate the effectiveness of the number connection test, сritical flicker frequency test and an electroencephalography in the diagnosis of encephalopathy in patients with hepatic and extrahepatic form of portal hypertension. Materials and methods. Syndrome of hepatic encephalopathy was studied in 50 patients with hepatic form of portal hypertension, 30 — with extrahepatic form of portal hypertension and 25 persons without signs of portal hypertension. For the diagnosis, number connection test, сritical flicker frequency test and an electroencephalography were used. Results. A simple-to-use and number connection test made it possible to establish manifestations of hepatic encephalopathy in almost all patients, regardless of the presence of portal hypertension and its form. However, manifestations of hepatic encephalopathy prevailed in patients with hepatic portal hypertension in terms of incidence and severity. Critical flicker frequency test allowed to diagnose minimal hepatic encephalopathy in 96.0 % of patients with hepatic portal hypertension and 60.0 % of patients with extrahepatic portal hypertension. The electroencephalography established the presence of hepatic encephalopathy in 60.0 % of patients with hepatic portal hypertension, 50.0 % — with extrahepatic portal hypertension and 12.0 % of individuals without portal hypertension. Conclusions. Comparison of the effectiveness of diagnostic tests showed that am easy to use and accessible number connection test is most effective, however, other tests also have benefits in the clinical evaluation of hepatic encephalopathy in patients with portal hypertension.


hepatic encephalopathy; diagnostics; number connection test; critical flicker frequency test; electroencephalography


Oksakova RS, Ilchenko LY, Lugovkina EA, Fedorov IF, Melnikova LI, Storogakov GI. Еxperience of application of psyllium in the treatment of liver encephalopathy in patients with chronic liver diseases. Arhiv vnutrennej mediciny. 2012;5(7):19-25. (in Russian).

Babak OYa, Kolesnikova EV. Ciroz pecheni [Cirrhosis and its complications]. Kiev: Zdorov`ja Ukrai'ny; 2011. 575 p.

Ardatskay MD, Minushkin ON. Modern approaches to the diagnosis and treatment of hepatic encephalopathy. Consilium Medicum. 2012;14(8):41-47. (in Russian).

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002 Mar;35(3):716-21. doi: 10.1053/jhep.2002.31250.

Yagmur VB, Melanich SL, Nedzvetska NV. Diagnosis of Minimal Hepatic Encephalopathy Using Neuropsychometric Tests. Hastroenterolohiya. 2015;56:33-37. (in Ukrainian).

Damulin IV. Hepatic encephalopathy: pathogenetic, clinical and therapeutic aspects. Hastroenterolohiya. 2006;2:54-59. (in Russian).

Cash WJ, McConville P, McDermott E, McCormick PA, Callender ME, McDougall NI. Current concepts in the assessment and treatment of Hepatic Encephalopathy. QJM. 2010 Jan;103(1):9-16. doi: 10.1093/qjmed/hcp152.

Montagnese S, Amodio P, Morgan MY. Methods for diagnosing hepatic encephalopathy in patients with cirrhosis: a multidimensional approach. Metab Brain Dis. 2004 Dec;19(3-4):281-312. PMID: 15554423.

Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver.. Hepatology. 2014 Aug;60(2):715-35. doi: 10.1002/hep.27210.

Amodio P, Montagnese S, Gatta A, Morgan MY. Characteristics of minimal hepatic encephalopathy. Metab Brain Dis. 2004 Dec;19(3-4):253-67. doi: 10.1023/

Guerit JM, Amantini A, Fischer C, et al. Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009 Jul;29(6):789-96. doi: 10.1111/j.1478-3231.2009.02030.x.

Randolph C, Hilsabeck R, Kato A, et al. Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009 May;29(5):629-35. doi: 10.1111/j.1478-3231.2009.02009.x.

Kozlov VK, Radchenko VG, Teterina LA, Yarilov SV. Sposob diagnostiki pechenochnoy encefalopatyi latentnoy stadia u bolnih hronicheskimi zabolevaniyami pecheni [The method of diagnosis of latent stage hepatic encephalopathy in patients with chronic liver diseases]. Patent RF No. 2468745, 2010.

Torlot FJ, McPhail MJ, Taylor-Robinson SD. Meta-analysis: the diagnostic accuracy of critical flicker frequency in minimal hepatic encephalopathy. Aliment Pharmacol Ther. 2013 Mar;37(5):527-36. doi: 10.1111/apt.12199.

Montagnese S, Biancardi A, Schiff S, et al. Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis. Hepatology. 2011 Feb;53(2):558-66. doi: 10.1002/hep.24043.

Bajaj JS, Cordoba J, Mullen KD, et al. Review article: the design of clinical trials in hepatic encephalopathy – an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement. Aliment Pharmacol Ther. 2011 Apr;33(7):739-47. doi: 10.1111/j.1365-2036.2011.04590.x.

Nadinskaya MYu. Test svyazi chisel: Rucovodstvo dlya vrachey [The test of the connection of numbers: A guide for doctors]. Moskow; 2000. 11 p.

Lauridsen MM, Jepsen P, Vilstrup H. Critical flicker frequency and continuous reaction times for the diagnosis of minimal hepatic encephalopathy: a comparative study of 154 patients with liver disease. Metab Brain Dis. 2011 Jun;26(2):135-9. doi: 10.1007/s11011-011-9242-1.

Copyright (c) 2017 GASTROENTEROLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта