Chronic persistent hepatic encephalopathy

Rare complications of liver cirrhosis are chronic persistent hepatic encephalopathy and hepatic myelopathy. Both occur in less than 1% of the patients, and both are accompanied by extensive porto-systemic shunts. Chronic persistent hepatic encephalopathy is also known as acquired hepato-lenticular degeneration (Victor, Adams and Cole, 1965). In contrast to the nsnal cirrhotic patient with HE, these patients show obvions neuronal alterations a patchy, spongy degeneration most consistently observed in the deep layers of the cerebral cortex and subcortical white matter, particularly in the parieto-occipital cortex, basal ganglia and cerebellum. 

Liver biopsies performed in patients with chronic HBV infection are classified as chronic persistent hepatitis, chronic active hepatitis, and cirrhosis. Histologic results do not correlate with symptoms and often patients are asymptomatic until the development of cirrhosis. " Cirrhosis is manifested by interlacing strands of fibrous tissue with nodules of regenerating cells resulting in a characteristic small and knobby-appearing liver. This form of injury is irreversible and can be exacerbated by heavy alcohol consumption and concomitant infection with HCV or HIV. Hepatic decompensation as a result of cirrhosis includes ascites, jaundice, variceal bleeding, and hepatic encephalopathy. The 5-year risk of decompensation after the development of cirrhosis is estimated to be 20%. ... 

In the case of chronic liver disease, episodic HE and persistent HE were defined and the term minimal hepatic encephalopathy (MHE) was coined to replace the hitherto inappropriate term subclinical encephalopathy . It is expected that this new system of classification will help to dispel the confusion frequently present in current textbook definitions and to facilitate multi-centre clinical trials in HE. 

A 33-year-old chronic alcoholic with hepatitis C developed acute liver and renal insufficiency with grade III encephalopathy. Hemodialysis was begun and emergency liver transplantation was performed. The explanted liver showed marked diffuse macrovesicular steatosis with massive coagulative-type necrosis. The postoperative course included a persistently raised gamma-glutamyltransferase, but he recovered fully after 60 days. 

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