Hepatocerebral dysfunction.

The neurological manifestations associated with acquired liver disorders of various types may present difficult diagnostic problems until the condition is far advanced. Bizarre psychological and motor disorders occur when the central nervous system is affected by liver disease. The clinical features may in some ways resemble those of Wilson's disease, but such features as remitting coma, fetor hepaticus and seizures in "cholemia," and a Kaiser-Fleischer ring in hepatolenticular degeneration help to distinguish the two conditions. The biochemical abnormalities found in all types of hepatocerebral dysfunction may be quite similar one to another. While many studies suggest that the whole problem is simply the result of brain intoxication by a substance such as ammonia, other lines of evidence indict several factors in intermediate cerebral and liver metabolism. The treatment involves use of substances which may relieve certain blocks in biochemical processes, supplementary vitamins, low protein intake and strict avoidance of all neuro- and hepatotoxins.