title: Neurophysiological evidence of cognitive impairment in patients without hepatic encephalopathy after transjugular intrahepatic portosystemic shunts.
abstract: 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.
authors.affiliation: Department of Medicine IV, University of Vienna Medical School, Vienna General Hospital, Austria.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kramer
authors.forename: Edith
authors.initials: E
authors.lastname: Bauer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gendo
authors.forename: Georg
authors.initials: G
authors.lastname: Funk
authors.forename: Christian
authors.initials: C
authors.lastname: Madl
authors.forename: Johann
authors.initials: J
authors.lastname: Pidlich
authors.forename: Alfred
authors.initials: A
authors.lastname: Gangl
mesh_terms: 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