MISCELLANEA ON ENCEPHALOPATHIES – A SECOND LOOK Edited by Radu Tanasescu Miscellanea on Encephalopathies – A Second Look Edited by Radu Tanasescu Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Molly Kaliman Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published June, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Miscellanea on Encephalopathies – A Second Look, Edited by Radu Tanasescu p. cm. ISBN 978-953-51-0558-9 Contents Preface IX Chapter 1 Minimal Hepatic Encephalopathy (MHE) 1 Daniela Benedeto-Stojanov and Dragan Stojanov Chapter 2 Uremic Encephalopathy 23 Annemie Van Dijck, Wendy Van Daele and Peter Paul De Deyn Chapter 3 Drug-Induced Encephalopathy 39 Niels Hansen Chapter 4 Sonographic Changes in Hypoxic-Ischaemic Encephalopathy 61 Pilvi Ilves Chapter 5 Neoplasm Related Encephalopathies 91 Lore Lapeire, Anne Sieben, Patrick Santens and Simon Van Belle Chapter 6 Hepatic Encephalopathy 121 Jeffrey E. Juneau and Brendan M. McGuire Chapter 7 Hypoxic Encephalopathy 149 Mireia Moragas Garrido and Jordi Gascón Bayarri Chapter 8 Encephalopathy Associated with Psychotropic Drug Therapy 167 Yuji Odagaki Chapter 9 The Use of Microdialysis in the Study of Encephalopathies 199 Liliana Carmona-Aparicio, Liliana Rivera-Espinosa and Hugo Juárez-Olguín Chapter 10 Portal-Systemic Encephalopathy in Emergency Treatment of Cirrhosis and Bleeding Esophageal Varices 225 Marshall J. Orloff VI Contents Chapter 11 Future Perspectives for the Treatment of Neonatal Hypoxic-Ischemic Encephalopathy 243 Pedro M. Pimentel-Coelho, Marcelo F. Santiago and Rosalia Mendez-Otero Chapter 12 Molecular Defects of Vitamin B 6 Metabolism Associated with Neonatal Epileptic Encephalopathy 267 Mohini S. Ghatge, Martino L. Di Salvo, Roberto Contestabile, Dorothy N. Eseonu, Sayali Karve, Verne Schirch and Martin K. Safo Chapter 13 Disaccharides in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis 291 Praveen Sharma Chapter 14 Dopaminergic Dysfunction in Experimental Hepatic Encephalopathy 309 Isabel Suárez, Guillermo Bodega and Benjamín Fernández Chapter 15 Wernicke’s Encephalopathy 327 Radu Tanasescu, Laura Dumitrescu, Carmen Dragos, Dimela Luca, Alexandra Oprisan, Catalina Coclitu, Oana Simionescu, Lorena Cojocaru, Marius Stan, Andreea Carasca, Andreea Gitman, Adela Chiru and Marina Ticmeanu Chapter 16 L-carnitine in Hyperammonemia and Hepatic Encephalopathy 365 Jane Missler and Claudia Zwingmann "There is only one good, knowledge, and one evil, ignorance" Socrates Preface The brain is an exceptionally complex structure anatomically, physiologically and pharmacologically. A vast spectrum of perturbations can impact its function. ‘Encephalopathy’ is a non-specific term for any diffuse disease of the brain altering brain function or structure. Etymologically the word has Greek roots (i.e. ‘encephalo’ and ‘pathy’) that translate as 'suffering of the brain'. However, under this ‘umbrella’ are grouped a plethora of brain disturbances with various etiologies including infectious, metabolic, toxic or immune conditions. Nevertheless, the medical concept of encephalopathy is slightly more restrictively used, commonly designating only non-focal, structural or only functional, more or less reversible or progressive diseases of the brain disrespectful of their cause. Though one may argue the need for a more rigid definition, this would not serve my purpose of drawing attention to the vast spectrum of diseases grouped under the concept of encephalopaties and at the same time to the great variety of etiologies, mechanisms and clinical expressions of this diseases. Therefore, as already understood by the reader of the previous book 'Miscellanea on Encephalopathies' one may and should not aspire to an exhaustive coverage on the subject. In the same spirit of the previous book and guided by the same need of completing the ever changing kaleidoscopic mosaic of the spectrum of encephalopathies by putting together more or less detailed pieces written by authors with expertise in the chosen field, I propose to you 'Miscellanea on Encephalopathies: a Second Look'. As the previous book, the present one addresses not only neurologists, but also fellow physicians of various specialties and medical researchers. I take great honor in thanking the colleagues that contributed to the developing of this book by sharing their experience and knowledge. Along with them I hope that this second attempt to group aspects related to different encephalopathies adds important information to the one offered by the previous book and I put great hope in the future collaborations that will help us to build more comprehensive and up to date view on this broad topic. Radu Tanasescu University of Medicine and Pharmacy "Carol Davila" Bucharest, Department of Neurology, Colentina Hospital, Romania [...]... and hyperammonaemia, suggesting a role for serotonin in early neuropsychiatric symptoms of HE.24 3.3 Branched-chain amino acids (BCAA) and false neurotransmitters An imbalans between aromatic aminoacids (AAA) (phenylalanine, tryptophan and tyrosine) and branched-chain amino acids (BCAA)(leucine, isoleucine and valine) has been described in patients with severe liver dysfunction AAA and BCAA share a. .. 2007;25:1 1–1 6 18 Miscellanea on Encephalopathies – A Second Look [8] Kharbanda PS, Saraswat VA, Dhiman RK Minimal hepatic encephalopathy: diagnosis by neurophchological and neurophysiological methods Indian J Gastroenterol 2003; 22: 53 7–5 41 [9] Ortiz M, Jacas C, Cordoba J Minimal hepatic encephalopathy: diagnosis, clinical signifi cance and recommendations J Hepatol 2005;42: 4 5–5 3 [10] Lockwood AH “What’s... Classification of hepatic encephalopathy 2 Miscellanea on Encephalopathies – A Second Look Minimal hepatic encephalopathy (MHE), the mildest form of HE, is characterized by subtle motor and cognitive deficits, and impairs health-related quality of life (HRQOL).2 Cirrhotic patients with MHE have a normal neurological and mental status by the standards of clinical examination, yet demonstrate quantifiable... frontal rhythmic theta activity and paroxysmal, bilateral, high voltage delta waves are also frequent Sometimes bilateral spike-waves complexes or triphasic waves in the frontal regions are found (Fig 1) Convulsions are often a late stage manifestation of chronic renal failure Seizures are usually generalized tonic-clonic convulsions Nevertheless, focal motor seizures are not uncommon Epilepsia partialis... battery examines many of the abnormalities seen in patients with MHE, including motor speed and accuracy, visuo-spatial orientation, visual perception, visual construction, attention, concentration, and, to a lesser extent, memory PHES has a prognostic value for the occurrence of overt HE and mortality in cirrhotic patients.74,75 12 Miscellanea on Encephalopathies – A Second Look The RBANS contains measures... permeability-surface area product of the blood–brain barrier permits ammonia to diffuse across the blood–brain barrier into the brain more freely than normal This may cause ammonia-induced encephalopathy even though arterial ammonia levels are normal or near normal Cognitive deficits observed in patients with noncirrhotic portal hypertension have also been linked to ammonia.18 Patients with noncirrhotic portal hypertension,... neuropsychological performance Alterations in cerebral blood flow and glucose metabolism induced by ammonia are associated with a significant decrease of glucose utilization by various cortical regions that are involved in cognitive functions.21 The cerebral metabolic rate for ammonia and the permeability-surface area product for ammonia are significantly higher in patients with MHE.21 The increased permeability-surface... minimal hepatic encephalopathy Hepatology 2008; 47: 59 6–6 04 [53] Venktaramarao SH, Mittal, Prabhakar S, Dhiman RK Brain perfusion single photon emission computed tomography (SPECT) abnormalities in patients with minimal hepatic encephalopathy (abstract) J Gastroenterol Hepatol 2008; 23 : A6 2 [54] Grover VP, Dresner MA, Forton DM, et al Current and future applications of magnetic resonance imaging and... spectroscopy alterations and cerebral ammonia and glucose metabolism in cirrhotic patients with and without hepatic encephalopathy Gut 2007; 56: 173 6–4 2 [96] Lodi R, Tonon C, Stracciari A et al Diffusion MRI shows increased water apparent diffusion coefficient in the brains of cirrhotics Neurology 2004; 62: 76 2–6 [97] Kale RA, Gupta RK, Saraswat VA et al Demonstration of interstitial cerebral edema with... criteria (Table 2).6 Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Lack of detectable changes in personality or behavior No asterixis Trivial lack of awareness Euphoria or anxiety Shortened attention span Impaired performance of addition Asterixis may be present Lethargy or apathy Minimal disorientation for time or place Subtle personality change Inappropriate behavior, slurred speech Impaired performance . 327 Radu Tanasescu, Laura Dumitrescu, Carmen Dragos, Dimela Luca, Alexandra Oprisan, Catalina Coclitu, Oana Simionescu, Lorena Cojocaru, Marius Stan, Andreea Carasca, Andreea Gitman, Adela Chiru . MISCELLANEA ON ENCEPHALOPATHIES – A SECOND LOOK Edited by Radu Tanasescu Miscellanea on Encephalopathies – A Second Look Edited by Radu Tanasescu Published. noted on measures such as the grooved pegboard task, 57,58 and on line tracing tasks (the latter also involve visuospatial abilities). 66,67 Miscellanea on Encephalopathies – A Second Look