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Brain edema: a valid endpoint for measuring hepatic encephalopathy?

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Abstract

Hepatic encephalopathy (HE) is a major complication of liver failure/disease which frequently develops during the progression of end-stage liver disease. This metabolic neuropsychiatric syndrome involves a spectrum of symptoms, including cognition impairment, attention deficits and motor dysfunction which eventually can progress to coma and death. Pathologically, HE is characterized by swelling of the astrocytes which consequently leads to brain edema, a common feature found in patients with acute liver failure (ALF) as well as in cirrhotic patients suffering from HE. The pathogenic factors involved in the onset of astrocyte swelling and brain edema in HE are unresolved. However, the role of astrocyte swelling/brain edema in the development of HE remains ambiguous and therefore measuring brain edema as an endpoint to evaluate HE is questioned. The following review will determine the effect of astrocyte swelling and brain edema on neurological function, discuss the various possible techniques to measure brain edema and lastly to propose a number of neurobehavioral tests to evaluate HE.

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Abbreviations

HE:

Hepatic encephalopathy

ALF:

Acute liver failure

GFAP:

Glial fibrillary acid protein

CSF:

Cerebrospinal fluid

RVD:

Regulatory volume decrease

MRI:

Magnetic resonance imaging

DWI:

Diffusion weighted imaging

FLAIR:

Fast fluid-attenuated inversion recovery

BDL:

Bile-duct ligation

PCA:

Portacaval anastomosis

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Authors and Affiliations

  1. Département de nutrition, Université de Montréal, Montréal, Québec, Canada

    Chantal Bémeur

  2. Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, Montréal, Québec, Canada

    Chantal Bémeur & Christopher F. Rose

  3. Centre d’Imagerie Biomédicale (CIBM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Cristina Cudalbu

  4. Department of Medicine V (Hepatology and Gastroenterology), Aarhus, Denmark

    Gitte Dam

  5. Department of Ophthalmology, Haukeland University Hospital, 5012, Bergen, Norway

    Alexander S. Thrane

  6. Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, 14642, USA

    Alexander S. Thrane

  7. Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York, 10595, USA

    Arthur J. L. Cooper

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  1. Chantal Bémeur
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  2. Cristina Cudalbu
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Correspondence to Christopher F. Rose.

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Bémeur, C., Cudalbu, C., Dam, G. et al. Brain edema: a valid endpoint for measuring hepatic encephalopathy?. Metab Brain Dis 31, 1249–1258 (2016). https://doi.org/10.1007/s11011-016-9843-9

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