A brain disorder caused by liver damage, which is usually a chronic condition and can lead to irreversible neurological symptoms.

Alternative Names

Chronic acquired (non-Wilsonian) hepatocerebral degeneration

Causes, incidence, and risk factors

Liver damage can lead to the accumulation of ammonia and other toxic materials when the organ doesn't function properly to metabolize and excrete them. These chemicals can destroy brain tissue, leading to coma and potentially death. Specific brain areas, such as the basal ganglia, appear to be more susceptible to injury caused by liver failure. Since the basal ganglia are involved in the regulation of movement, people affected by this disorder may develop tremors, twitching, involuntary movements and other neurologic symptoms. Hepatocerebral degeneration and the neurological syndrome it causes may occur in any case of acquired liver failure including alcoholic hepatitis, autoimmune hepatitis, viral hepatitis, and others.

Signs and tests

A thorough neurological examination may reveal signs of dementia, involuntary movements, and gait instability. Other physical signs of liver disease such as ascites (distended abdomen filled with fluid) and jaundice (yellow color to the skin and whites of eyes) may be evident. Laboratory studies may show an elevated ammonia level and abnormal liver function tests. Imaging studies of the head may not show any abnormalities or may show non-specific changes in the basal ganglia. An EEG test may show diffuse slowing consistent with an abnormal metabolic process. Diagnosis is based on these neurological findings in seen in the setting of known liver impairment.

Treatment

Treatment is aimed at reducing the metabolic by-products that accumulate due to liver failure. This may include laxatives such as lactulose that lower the level of ammonia in the blood. There is no specific treatment of the neurologic syndrome as it is due to the liver disease. A liver transplant may be curative of the liver disease but the neurological symptoms may or may not be reversible.

Expectations (prognosis)

The natural history of this illness is progressive worsening with eventual death if the liver is not replaced by transplant. If a transplant occurs early in the course of the disease, the neurological syndrome may be reversible.

Complications

Complications include hepatic coma and severe brain damage.

Calling your health care provider

Call your healthcare provider if you have any signs or symptoms of liver disease.

Prevention

It is not possible to prevent all forms of liver disease, but alcoholic and viral hepatitis are potentially preventable. Not drinking, drinking only in moderation, and avoidance of risky behavior such as IV drug use (particularly sharing needles and other injection paraphernalia) and unprotected sexual encounters can significantly decrease the risk of acquiring alcoholic or viral hepatitis.