El-Sherif, A., Abdelrazik, F., Helal, A., Ali, A., Abdelsayed, M. (2018). Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a Combination of Neuropsychiatric and Neurophysiological Tests. The Egyptian Journal of Hospital Medicine, 73(4), 6541-6554. doi: 10.21608/ejhm.2018.15411
Assem Mahmoud El-Sherif; Fathy Ghamry Abdelrazik; Ahmed Elwassief Helal; Ahmed Essmet Ali; Mohamed Mahmoud Abdelsayed. "Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a Combination of Neuropsychiatric and Neurophysiological Tests". The Egyptian Journal of Hospital Medicine, 73, 4, 2018, 6541-6554. doi: 10.21608/ejhm.2018.15411
El-Sherif, A., Abdelrazik, F., Helal, A., Ali, A., Abdelsayed, M. (2018). 'Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a Combination of Neuropsychiatric and Neurophysiological Tests', The Egyptian Journal of Hospital Medicine, 73(4), pp. 6541-6554. doi: 10.21608/ejhm.2018.15411
El-Sherif, A., Abdelrazik, F., Helal, A., Ali, A., Abdelsayed, M. Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a Combination of Neuropsychiatric and Neurophysiological Tests. The Egyptian Journal of Hospital Medicine, 2018; 73(4): 6541-6554. doi: 10.21608/ejhm.2018.15411
Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a Combination of Neuropsychiatric and Neurophysiological Tests
1Department of Internal Medicine, Faculty of Medicine, Al-Azhar University
2Department of Neurology,Faculty of Medicine, Al-Azhar University
Abstract
Background: Minimal Hepatic Encephalopathy (MHE) is characterized by mild cognitive impairment, attention deficits, psychomotor slowing and impaired vasomotor and bimanual coordination. These non-evident symptoms can be revealed with neuro psycho metric and neuro physiological testing. Aim: to validate a comprehensive set of neuropsychiatric test battery in addition to the neuro physiological tests in detecting MHE. Patients and Methods: Thirty patients with liver cirrhosis and no clinical evidence of HE were selected for this study. Patients underwent laboratory screening, Neuropsychiatric and Neuro physiological tests. Results: Impairment of at least one psychometric test was documented in 50% of patients, with 50% abnormal NCTA, 46.7% abnormal DST and 40% abnormal LTT. VEP records showed prolonged P100 in 46.7% of patients with 40% prolongation of P100 in the right eye and 46.7% in the left eye. EEG recording was abnormal in 43.3% patients and the recorded abnormalities included; slow theta waves in 33% of patients, slow delta waves 10%, and 56% had normal EEG. Conclusion: The incidence of MHE can vary according to the strategy of diagnosis and while strict dependence on neuropsychiatric tests can diagnose MHE in 50% of patients, adopting a more strict policy that incorporate neuro physiological tests can limit the diagnosis 40% of patients. There is moderate concordance between neuropsychiatric and neurophysiologic tests.
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