Features of encephalopathy diagnosis in patients with portal hypertension syndrome

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

Abstract


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.

Keywords


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

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DOI: https://doi.org/10.22141/2308-2097.51.4.2017.119291

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