Neurophysiological evidence of cognitive impairment in patients without hepatic encephalopathy after transjugular intrahepatic portosystemic shunts.
OBJECTIVE
We aimed to test the hypothesis that subclinical cognitive brain dysfunction in cirrhotic patients would deteriorate after a transjugular intrahepatic portosystemic shunt (TIPS) in the absence of clinically detectable hepatic encephalopathy.


METHODS
Out of 49 consecutive cirrhotic patients receiving elective TIPS for recurrent variceal hemorrhage, we identified 22 patients who were not encephalopathic and had not undergone liver transplantation at 6-month follow-up and confirmed TIPS patency by Doppler ultrasound. Patients were tested before and 6 months after TIPS implantation using event-related (P300) cognitive evoked potentials, late somatosensory median nerve (N70) potentials, and standard psychometric tests (Mini-Mental State and trailmaking test A). Twenty-two age-matched healthy subjects served as controls.


RESULTS
Relative to controls, patients showed significantly impaired P300 and N70 latencies and abnormal psychometric test results at baseline. Six months after the TIPS, a further impairment of P300 latency was observed (p = 0.005), whereas no relevant changes in N70 latency and psychometric test results occurred.


CONCLUSIONS
In cirrhotic patients with portal hypertension, neurophysiological signs of cognitive brain dysfunction are detectable in the absence of hepatic encephalopathy. A further subclinical deterioration of cognitive processing was observed 6 months after the TIPS. These findings demonstrate an aggravation of subclinical hepatic encephalopathy after a TIPS.
Kramer
Ludwig
L
Department of Medicine IV, University of Vienna Medical School, Vienna General Hospital, Austria.
Bauer
Edith
E
Gendo
Alexandra
A
Funk
Georg
G
Madl
Christian
C
Pidlich
Johann
J
Gangl
Alfred
A
D000328:Adult; D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000379:methods; D011336:Probability; D012307:Risk Factors; D017678:Sex Distribution; D018709:Statistics, Nonparametric