title: Minimal hepatic encephalopathy in patients with liver cirrhosis: magnetic resonance spectroscopic brain findings versus neuropsychological changes.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy (MHE) is a subtle complication of cirrhosis that may have a detrimental effect on daily functioning and may progress to overt hepatic encephalopathy (HE). The aims of this study were to identify MHE and assess neuropsychological changes in those patients.
  
  
  METHODS
  A case-control study was conducted in 35 cirrhotic patients. MHE was identified by brain (hydrogen-1) magnetic resonance spectroscopy ((1)H-MRS). Neuropsychological changes were evaluated using cognitive abilities screening instrument (CASI) test, Hamilton depression scale, and soft neurological sign assessment.
  
  
  RESULTS
  Of the patients, 16 (45.7%) had significant brain (1)H-MRS findings suggesting MHE in the form of decreased myo-Inositol/creatine (mI/Cr) and choline/creatine (Cho/Cr) ratios and increased glutamine-glutamate/creatine (Glx/Cr) ratios in white and grey matters compared to patients without MHE and healthy controls. Patients with MHE had significantly lower abstract thinking subset and total CASI score in comparison to patients without MHE (p=0.03 and p=0.05, respectively) and controls (p=0.003 and p=0.02, respectively). No statistically significant differences were observed amongst different groups regarding other CASI subsets, depression, and soft neurological assessment in spite of a tendency towards increased values in patients with MHE.
  
  
  CONCLUSIONS
  MHE associated with neurophysiological changes demonstrated by (1)H-MRS preceded neuropsychological changes. Thus, (1)H-MRS may be considered as a potential tool for diagnosis of cirrhosis-associated cerebral dysfunction and a promising method for prioritisation of subjects awaiting liver transplantation.
authors.affiliation: Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: mam_elham75@yahoo.com.
authors.forename: Elham A
authors.initials: EA
authors.lastname: Hassan
authors.affiliation: Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Abeer S
authors.initials: AS
authors.lastname: Abd El-Rehim
authors.affiliation: Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Gehan S
authors.initials: GS
authors.lastname: Seifeldein
authors.affiliation: Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ghaydaa A
authors.initials: GA
authors.lastname: Shehata
mesh_terms: D000328:Adult; D001921:Brain / Q000378:metabolism*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003401:Creatine / Q000032:analysis*; D005260:Female; D005973:Glutamine / Q000032:analysis*; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D007294:Inositol / Q000032:analysis*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies
chemical_list: D005973:Glutamine; D007294:Inositol; D003401:Creatine