title: Cerebral white matter lesions in patients with cirrhosis - causative for hepatic encephalopathy or bystanders?
abstract: OBJECTIVE
  Focal white matter lesions mimicking microvascular lesions were connected to the development of hepatic encephalopathy (HE) in patients with cirrhosis. This study aims to assess the relationship between cerebrovascular risk factors and the prevalence and extent of these lesions in patients with cirrhosis, as well as their impact upon cognitive function.
  
  
  METHODS
  55 cirrhotic patients underwent neurological examination, psychometric testing and magnetic resonance imaging. T2-weighted images were reviewed for white matter lesions by a neuroradiologist and a neurologist, independently. Patients were allocated into three groups: (i) no or <5, (ii) 6-15 and (iii) more than 15 lesions. Allocation was confirmed by a senior neuroradiologist blinded for the clinical data. The patient groups were compared concerning age, underlying liver disease, mortality, MELD Score, history of HE, treatment for HE, cerebrovascular risk factors and psychometric test results. Regression analysis was performed to identify risk factors for the presence and extent of white matter lesions.
  
  
  RESULTS
  Patient groups 2 and 3 were older and showed worse results in the psychometric tests than group 1 (P < 0.05). Correlation analyses showed a significant relationship between the number of white matter lesions and the grade of HE (P < 0.001) and cognitive function (P < 0.05), but no interrelationship between the lesions and cerebrovascular risk factors or other factors tested.
  
  
  CONCLUSIONS
  Focal white matter lesions in patients with cirrhosis do not represent cerebrovascular small-vessel disease but are related to the pathology of HE. Further studies are needed to clarify the mechanisms behind in detail.
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.|Integrated Research and Treatment Centre Transplantation, Hannover, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Pflugrad
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Bronzlik
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Raab
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.|Integrated Research and Treatment Centre Transplantation, Hannover, Germany.
authors.forename: Anita B
authors.initials: AB
authors.lastname: Tryc
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.|Integrated Research and Treatment Centre Transplantation, Hannover, Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Goldbecker
authors.affiliation: Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Barg-Hock
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|Department of Medicine I, University Hospital Bonn, Bonn, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.
authors.forename: Xiao-Qi
authors.initials: XQ
authors.lastname: Ding
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Lanfermann
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.|Integrated Research and Treatment Centre Transplantation, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D006801:Humans; D056784:Leukoencephalopathies / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D011594:Psychometrics; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014850:Waiting Lists; D055815:Young Adult
keywords: cerebrovascular risk factors; cognitive function; psychometric hepatic encephalopathy score (PHES); subcortical arteriosclerotic encephalopathy; white matter lesions