Asterixis

Levels greater than 400 mcg/mL may result in respiratory alkalosis, hemorrhage, excitement, confusion, asterixis (involuntary jerking movements especially... 

Markers of hepatic encephalopathy include decreased cognition, confusion, changes in behavior, and asterixis. 

In fulminant hepatitis with hepatic encephalopathy, patients may have asterixis and coma. 

Severe, acute respiratory acidosis produces a variety of neurologic abnormalities. Initially these include headache, blurred vision, restlessness, and anxiety. These may progress to tremors, asterixis, somnolence, and/or delirium. If untreated, terminal manifestations include peripheral vasodilation leading to hypotension and cardiac arrhythmias. Chronic respiratory acidosis is typically associated with cor pulmonale and peripheral edema. 

Asterixis Abnormal posture and movements that may occur in advanced liver disease and a few other circumstances. 

Fera et al. 55 Lactulose (double-blind) 14 consecutive days each month for 3 months Mental status, asterixis, cancellation test, Reitan test, EEG, NH3, PSE severity E Rif > Lac T Rif> Lac... 

Miglio et al. 58 Neomycin (double-blind) 14 consecutive days each month for 6 months Disturbances in speech, memory, behavior and mood, gait, writing, asterixis, NH3, Reitan test E Rif = Neo T Rif > Neo... 

Williams et al. 59 3 different rifaximin dose regimens 200 mg x 3 400 mg x 3 800 mg x 3 (double-blind) 7 days HE index, mental status, asterixis, Reitan test, EEG, NH3 E Rif 800 mg x 3 > other doses No clear dose response explained by the short treatment period T good for all doses... 

Mas et al. 62 Lactitol (double-blind) 5-10 days HE index, mental status, asterixis, NH3, number connection test, EEG E Rif >Lat T Rif = Lat... 

Uremic and dialysis encephalopathies. Patients with renal failure continue to manifest neuropsychiatric symptoms despite significant advances in therapeutics and management. Patients with renal failure who are not yet on dialysis develop an array of symptoms, including clouding of consciousness, disturbed sleep patterns, tremor and asterixis that may progress to coma and death. 

Encephalopathy - Impaired cognition confusion obtundation altered mental status auditory/visual hallucinations psychosis (delirium, paranoia) mood changes (eg, mania, agitation, combativeness) diffuse hypotonus hyperreflexia myoclonus tremor asterixis involuntary movements major motor seizures lethargy/stupor/coma diffuse weakness. Approximately one-third of patients with a diagnosis of encephalopathy may have had... 

Mental status, and watch for signs of reduced ammonia level, such as lessening of asterixis... 

Cirrhosis is often asymptomatic until complications of liver disease are present. Mrs MW may present with itching, jaundice, dark urine, pale fatty stools, abdominal pain, nausea, fatigue, bleeding - such as nose bleeds, hepatic encephalopathy, hepatomegaly, ascites, distended abdominal veins, spider angiomata, palmar erythema and asterixis. She may also present with the signs and symptoms of alcohol withdrawal, which include irritability, anxiety, tachycardia, tremor, sweating, confusion and hallucinations. 

An 86-year-old man with a serum lithium concentration of 0.7 mmol/1 presented with a several month history of asterixis which resolved fully within 2 weeks of stopping lithium (178). 

High-dose aciclovir can cause disturbed cognition, changes in the level of consciousness, tremor, asterixis, hallucinations, and psychiatric syndromes. Often, symptoms of aciclovir toxicity are difficult to differentiate from neurological deterioration caused by Herpes encephalitis. 

Grade 2 Lethargic, time-disoriented, inappropriate, asterixis, ataxia, slovr triphasic v aves on EEG... 

The transition from the latent stage (SHE) to stage I of clinically manifest HE can be gradual, as demonstrated by the results of the psychometric tests. In this transitional zone (SHEI), there may occasionally be minor neurological findings, such as hyperreflexia, fine tremor or asterixis. (s. p. 272) (s. tab. 15.5)... 

II Somnolence Lethargy Loss of time consciousness Numeracy i i Memory impairment Disorientation Reduced inhibitions screaming aggression apathy exhibitionism inadequate or peculiar reactions inability to keep one s distance Asterixis (+), + Dysarthria + + Apraxia + + Reflexes + +, Primitive reflexes + Dissociated bulbus movements Hypertonicity + + + (as far as can stiU be tested) + Deceler- ation... 

Symptoms of neurotoxicity, which usually appear within the first 24—72 hours of administration, include tremor, myoclonus, confusion, lethargy, agitation, hallucinations, dysarthria, asterixis, ataxia, hemiparesthesia, and seizures. While aciclovir-induced neurotoxicity is most prevalent with intravenous administration, it has also been reported after oral use in patients with terminal renal insufficiency on hemodialysis. 

Asterixis, dystonias, and dyskinesias (including motor tics, orofacial and lingual dyskinesias, and oculogyric crises) are uncommon, as are auditory disturbances (SED-13,146) (13-15), (SEDA-20,60) (SEDA-21,69). 

Neurotoxicity has been reported with intracerebroventricular cefazolin (12) and with systemic cefazolin (13-15), cefepime (16), cefotaxime (17-19), ceftazidime (20,21), and cefuroxime (22). Ceftazidime also caused truncal asterixis (23) and absence status and toxic hallucinations (24). Even the least epileptogenic of 15 cephalosporins, namely cefonicid (11), caused seizures (25), although this effect was disputed (26). As expected, seizures after systemic treatment were predominant in uremic patients, and neurotoxicity has been associated with intraperitoneal ceftazidime therapy in a patient... 

Hillsley RE, Massey EW. Truncal asterixis associated with ceftazidime, a third-generation cephalosporin. Neurology 1991 41(12) 2008. 

A 60-year-old woman with post-herpetic neuralgia developed asterixis after having taken gabapentin for 4 days (18). The authors proposed that the mechanism was GABAergic. 

Transient neurological changes after myelography include asterixis, aphasia, and reversible visual defects. In one patient, asterixis and head bobbing were still present 3 months after myelography with metrizamide (SEDA-7, 453). An isolated case of persistent cervical myelopathy has also been reported after lumbar myelography with metrizamide. 

Asterixis, a jerky relaxation of tonically contracted postural muscles, was observed in some patients with structural lesions of the brain or metabolic encephalopathy who were taking levodopa, but not in patients with Parkinson s disease (10). 

Glantz R, Weiner WJ, Goetz CG, Nausieda PA, Klawans HL. Drug-induced asterixis iu Parkiuson disease. Neurology 1982 32(5) 553-5. 

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