Neurological Manifestations of Cirrhosis

Mohammad Ebrahimi

Hepatic Encephalopathy

Motor Symptoms

Motor Symptoms

  • Hypomimia
  • Hypo- and bradykinesia
  • Rigidity
  • Tremor
  • Dysarthria
  • Dysdiadochokinesia
  • ataxia

Motor Symptoms

Grade III and IV

  • Hyperreflexia
  • pyramidal signs
Hepatic encephalopathy motor symptoms

Writing and Speech

Writing and Speech

Early Phases

  • Tremulous writing
  • Omission of single letters
  • Reversal of order
  • Misspellings

Writing and Speech

Later Phases

  • Letters become superimposed
  • Lines of writing converge
  • Unable to sign
  • Unable to move the pencil from left to right

Personality Changes

Personality Changes

  • Becoming uninhibited and bizarre duo to
    • Difficulties in visual perception
    • Disorientation
    • Illusions
    • Hallucinations
  • Euphoria and depression fluctuations

Cirrhosis-related Parkinsonism

Comparison to idiopathic Parkinson disease

Similarities

Similarities

  • hopomimia
  • hypokinesia
  • tremor
  • rigidity

Differences

Differences

  • Do not develop the characteristic shuffling gait of PD
  • Have predominant involvement of their upper limbs
  • Symptoms develop faster
  • Symptoms are symmetric more often
  • Tremor occurs predominantly with action
  • Do not respond well to dopaminergic drugs

Hepatic Myelopathy

Hepatic Myelopathy

Rapidly progressive spastic paraparesis without accompanying sensory deficits or disturbances of bladder or bowel functions

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