Henning Pflugrad1,2, Paul Bronzlik3, Peter Raab3, Anita B Tryc1,2, Annemarie Goldbecker1,2, Hannelore Barg-Hock4, Christian P Strassburg5,6, Xiao-Qi Ding3, Heinrich Lanfermann3, Karin Weissenborn1,2. 1. Department of Neurology, Hannover Medical School, Hannover, Germany. 2. Integrated Research and Treatment Centre Transplantation, Hannover, Germany. 3. Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany. 4. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany. 5. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 6. Department of Medicine I, University Hospital Bonn, Bonn, Germany.
Abstract
BACKGROUND & AIMS: Focal white matter lesions mimicking microvascular lesions were connected to the development of hepatic encephalopathy (HE) in patients with cirrhosis. This study aims to assess the relationship between cerebrovascular risk factors and the prevalence and extent of these lesions in patients with cirrhosis, as well as their impact upon cognitive function. METHODS: 55 cirrhotic patients underwent neurological examination, psychometric testing and magnetic resonance imaging. T2-weighted images were reviewed for white matter lesions by a neuroradiologist and a neurologist, independently. Patients were allocated into three groups: (i) no or <5, (ii) 6-15 and (iii) more than 15 lesions. Allocation was confirmed by a senior neuroradiologist blinded for the clinical data. The patient groups were compared concerning age, underlying liver disease, mortality, MELD Score, history of HE, treatment for HE, cerebrovascular risk factors and psychometric test results. Regression analysis was performed to identify risk factors for the presence and extent of white matter lesions. RESULTS: Patient groups 2 and 3 were older and showed worse results in the psychometric tests than group 1 (P < 0.05). Correlation analyses showed a significant relationship between the number of white matter lesions and the grade of HE (P < 0.001) and cognitive function (P < 0.05), but no interrelationship between the lesions and cerebrovascular risk factors or other factors tested. CONCLUSIONS: Focal white matter lesions in patients with cirrhosis do not represent cerebrovascular small-vessel disease but are related to the pathology of HE. Further studies are needed to clarify the mechanisms behind in detail.
BACKGROUND & AIMS: Focal white matter lesions mimicking microvascular lesions were connected to the development of hepatic encephalopathy (HE) in patients with cirrhosis. This study aims to assess the relationship between cerebrovascular risk factors and the prevalence and extent of these lesions in patients with cirrhosis, as well as their impact upon cognitive function. METHODS: 55 cirrhotic patients underwent neurological examination, psychometric testing and magnetic resonance imaging. T2-weighted images were reviewed for white matter lesions by a neuroradiologist and a neurologist, independently. Patients were allocated into three groups: (i) no or <5, (ii) 6-15 and (iii) more than 15 lesions. Allocation was confirmed by a senior neuroradiologist blinded for the clinical data. The patient groups were compared concerning age, underlying liver disease, mortality, MELD Score, history of HE, treatment for HE, cerebrovascular risk factors and psychometric test results. Regression analysis was performed to identify risk factors for the presence and extent of white matter lesions. RESULTS:Patient groups 2 and 3 were older and showed worse results in the psychometric tests than group 1 (P < 0.05). Correlation analyses showed a significant relationship between the number of white matter lesions and the grade of HE (P < 0.001) and cognitive function (P < 0.05), but no interrelationship between the lesions and cerebrovascular risk factors or other factors tested. CONCLUSIONS: Focal white matter lesions in patients with cirrhosis do not represent cerebrovascular small-vessel disease but are related to the pathology of HE. Further studies are needed to clarify the mechanisms behind in detail.
Authors: Salvatore Petta; Antonino Tuttolomondo; Cesare Gagliardo; Rita Zafonte; Giuseppe Brancatelli; Daniela Cabibi; Calogero Cammà; Vito Di Marco; Luigi Galvano; Giuseppe La Tona; Anna Licata; Franco Magliozzo; Carlo Maida; Giulio Marchesini; Giovanni Merlino; Massimo Midiri; Gaspare Parrinello; Daniele Torres; Antonio Pinto; Antonio Craxì Journal: Medicine (Baltimore) Date: 2016-04 Impact factor: 1.889