CLINICAL MANIFESTATIONS AND NEUROLOGICAL COMPLICATIONS OF HEPATIC ENCEPHALOPATHY
DOI:
https://doi.org/10.51891/rease.v1i1.16225Keywords:
: “hepatic encephalopathy”, “neurological manifestations”, “complications”, “chronic liver disease” and “central nervous system”Abstract
Introduction: Hepatic encephalopathy (HE) is a complex brain dysfunction that occurs in individuals with chronic liver disease. This condition results from the inability of the diseased liver to metabolize toxic substances, which accumulate in the blood and affect the central nervous system. The clinical manifestations of HE are varied and can range from mild behavioral changes to coma, significantly impacting the quality of life of patients. Understanding the neurological manifestations and complications associated with HE is essential for early diagnosis and appropriate management of these patients. Objective: This systematic literature review aimed to identify and summarize the main clinical manifestations and neurological complications of hepatic encephalopathy, with emphasis on the cognitive, behavioral and motor changes associated with the disease. Methodology: A systematic search was performed in the PubMed, SciELO and Web of Science databases, using the descriptors “hepatic encephalopathy”, “neurological manifestations”, “complications”, “chronic liver disease” and “central nervous system”. The selection of studies included original articles published in the last 10 years, in Portuguese or English, that addressed the neurological manifestations of HE in adults. The following inclusion criteria were applied: observational studies, randomized clinical trials, and systematic reviews; patients with a confirmed diagnosis of chronic liver disease and HE; and articles that evaluated the neurological manifestations of the disease. The exclusion criteria were: animal studies, narrative reviews, and articles that did not address the neurological manifestations of HE. Study selection and data extraction were performed by two independent reviewers, using the PRISMA checklist. Results: The review identified a significant number of studies that addressed the neurological manifestations of HE. The results demonstrated that the most common neurological alterations include cognitive alterations, such as confusion, disorientation, and difficulty concentrating; behavioral alterations, such as irritability, apathy, and sleep disturbances; and motor alterations, such as asterixis and muscle rigidity. In addition, HE may be associated with other neurological complications, such as seizures and coma. The severity of neurological manifestations varies according to the etiology of liver disease, the stage of the disease and the presence of triggering factors. Conclusion: Hepatic encephalopathy is a complex condition that manifests itself by a wide range of neurological alterations, significantly impacting the quality of life of patients. Early diagnosis and appropriate treatment are essential to minimize complications and improve prognosis. Treatment of HE involves controlling the underlying liver disease, reducing blood ammonia levels and treating neurological complications. Understanding the clinical manifestations and neurological complications of HE is essential for the development of new therapeutic strategies and for improving the care of patients with chronic liver disease.
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