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Erschienen in: Der Nervenarzt 12/2003

01.12.2003 | Übersicht

Hepatische Enzephalopathie

verfasst von: Priv.-Doz. Dr. P. D. Schellinger, M. K. Hartmann, Ch. Klingmann, H. M. Meinck

Erschienen in: Der Nervenarzt | Ausgabe 12/2003

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Zusammenfassung

Die hepatische Enzephalopathie (HE) ist eine neuropsychiatrische Komplikation akuter und chronischer Lebererkrankungen. Ursache ist eine komplexe, metabolisch induzierte und damit potenziell reversible Funktionsstörung des Gehirns. Voraussetzung für die Diagnose einer HE ist der Nachweis einer Funktionsstörung des zentralen Nervensystems bei gleichzeitig bestehender Leberfunktionsstörung und sicherem Ausschluss einer neurologischen oder psychiatrischen Erkrankung anderer Ätiologie. Die Diagnose einer HE wird rein klinisch gestellt und umfasst ein weites Spektrum neuropsychiatrischer Symptome unterschiedlicher Schweregrade. Die ergänzende Zusatzdiagnostik beinhaltet labormedizinische Methoden, bildgebende Verfahren und neurophysiologische Zusatzuntersuchungen. Die Therapie der HE besteht im Wesentlichen aus der Behandlung und zukünftigen Vermeidung auslösender Faktoren, der Modulation metabolischer Prozesse sowie ultima ratio der Lebertransplantation. Die Prognose hängt von der Art und dem Verlauf der hepatischen Grunderkrankung ab.
Literatur
1.
Zurück zum Zitat Amodio P, Del Piccolo F, Marchetti P et al. (1999) Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29(6): 1662–1667 Amodio P, Del Piccolo F, Marchetti P et al. (1999) Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29(6): 1662–1667
2.
Zurück zum Zitat Amodio P, Marchetti P, Del Piccolo F et al. (1999) Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol 110(8): 1334–1344 Amodio P, Marchetti P, Del Piccolo F et al. (1999) Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol 110(8): 1334–1344
3.
Zurück zum Zitat Baktir G, Fisch HU, Karlaganis G (1987) Mechanism of the excessive sedative response of cirrhotics to benzodiazepines: model experiment with triazolam. Hepatology 7:629–638 Baktir G, Fisch HU, Karlaganis G (1987) Mechanism of the excessive sedative response of cirrhotics to benzodiazepines: model experiment with triazolam. Hepatology 7:629–638
4.
Zurück zum Zitat Basile AS, Gammal SH, Mullen KD, Jones EA, Skolnick P (1988) Differential responsiveness of cerebellar Purkinje neurons to GABA and benzodiazepin receptor ligands in an animal model of hepatic encephalopathy. J Neurosci 8:2414–2421 Basile AS, Gammal SH, Mullen KD, Jones EA, Skolnick P (1988) Differential responsiveness of cerebellar Purkinje neurons to GABA and benzodiazepin receptor ligands in an animal model of hepatic encephalopathy. J Neurosci 8:2414–2421
5.
Zurück zum Zitat Bergeron M, Reader TA, Pomier Layrargues G, Butterworth RF (1989) Monoamines and metabolites in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy. Neurochem Res 14:853–859 Bergeron M, Reader TA, Pomier Layrargues G, Butterworth RF (1989) Monoamines and metabolites in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy. Neurochem Res 14:853–859
6.
Zurück zum Zitat Bernthal P, Hays A, Tarter RE, van Thiel D, Lecky J, Hegedus A (1987) Cerebral CT scan abnormalities in cholestatic and hepatocellular disease and their relationship to neuropsychologic test performance. Hepatology 7:107–114 Bernthal P, Hays A, Tarter RE, van Thiel D, Lecky J, Hegedus A (1987) Cerebral CT scan abnormalities in cholestatic and hepatocellular disease and their relationship to neuropsychologic test performance. Hepatology 7:107–114
7.
Zurück zum Zitat Bucci L, Palmieri GC (1993) Double-blind, double-dummy comparison between treatment with rifaximin and lactulose in patients with medium to severe degree hepatic encephalopathy. Curr-Med Res Opin 13:109–118 Bucci L, Palmieri GC (1993) Double-blind, double-dummy comparison between treatment with rifaximin and lactulose in patients with medium to severe degree hepatic encephalopathy. Curr-Med Res Opin 13:109–118
8.
Zurück zum Zitat Butterworth RF (1995) Detection of benzodiazepines in hepatic encephalopathy: reply. Hepatology 2:605 Butterworth RF (1995) Detection of benzodiazepines in hepatic encephalopathy: reply. Hepatology 2:605
9.
Zurück zum Zitat Butterworth RF (2000) Complications of cirrhosis III. Hepatic encephalopathy. J Hepatol 32(1): 171–180 Butterworth RF (2000) Complications of cirrhosis III. Hepatic encephalopathy. J Hepatol 32(1): 171–180
10.
Zurück zum Zitat Butterworth RF (2000) Hepatic encephalopathy: a neuropsychiatric disorder involving multiple neurotransmitter systems. Curr Opin Neurol 13(6): 721–727 Butterworth RF (2000) Hepatic encephalopathy: a neuropsychiatric disorder involving multiple neurotransmitter systems. Curr Opin Neurol 13(6): 721–727
11.
Zurück zum Zitat Cordoba J, Blei AT (1997) Treatment of hepatic encephalopathy. Am J Gastroent 92:1429–1439 Cordoba J, Blei AT (1997) Treatment of hepatic encephalopathy. Am J Gastroent 92:1429–1439
12.
Zurück zum Zitat DeWaele JP, Audet RM, Rose C, Butterworth RF (1997) The portocaval-shunted rat: a new model for the study of the mechanisms controlling voluntary methanol consumption and ethanol dependence. Alcohol Clin Exp Res 21:305–310 DeWaele JP, Audet RM, Rose C, Butterworth RF (1997) The portocaval-shunted rat: a new model for the study of the mechanisms controlling voluntary methanol consumption and ethanol dependence. Alcohol Clin Exp Res 21:305–310
13.
Zurück zum Zitat Ferenci P (1991) Hepatische Enzephalopathie Klinik der Gegenwart, Urban & Schwarzenberg, München Wien Baltimore Ferenci P (1991) Hepatische Enzephalopathie Klinik der Gegenwart, Urban & Schwarzenberg, München Wien Baltimore
14.
Zurück zum Zitat Ferenci P (2001) Hepatic encephalopathy. Dtsch Med Wochenschr 126 [Suppl 1]: 76–80 Ferenci P (2001) Hepatic encephalopathy. Dtsch Med Wochenschr 126 [Suppl 1]: 76–80
15.
Zurück zum Zitat Ferenci P, Herneth A, Steindl P (1996) Newer approaches to therapy of hepatic encephalopathy. Semin Liver Dis 16:329–338 Ferenci P, Herneth A, Steindl P (1996) Newer approaches to therapy of hepatic encephalopathy. Semin Liver Dis 16:329–338
16.
Zurück zum Zitat Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic Encephalopathy—Definition, Nomenclature, Diagnosis, and Quantification: Final Report of the Working Party at the 11th World Congress of Gastroenterology, Vienna 1998. Hepatology 35:716–721 Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic Encephalopathy—Definition, Nomenclature, Diagnosis, and Quantification: Final Report of the Working Party at the 11th World Congress of Gastroenterology, Vienna 1998. Hepatology 35:716–721
17.
Zurück zum Zitat Fischer JE, Baldessarini RJ (1971) False neurotransmitters and hepatic failure. Lancet 2(7715): 75–80 Fischer JE, Baldessarini RJ (1971) False neurotransmitters and hepatic failure. Lancet 2(7715): 75–80
18.
Zurück zum Zitat Gabuzda Jr D, Philips GB, Davidson CS (1952) Reversible toxic manifestations in patients with cirrhosis of the liver given cation-exchange resins. N Engl J Med 246:124–130 Gabuzda Jr D, Philips GB, Davidson CS (1952) Reversible toxic manifestations in patients with cirrhosis of the liver given cation-exchange resins. N Engl J Med 246:124–130
19.
Zurück zum Zitat Gerok W (1984) Hepatische Enzephalopathie. Therapie mit adaptierten Aminosäuren- und Ketosäurengemischen. Therapiewoche 34:49–62 Gerok W (1984) Hepatische Enzephalopathie. Therapie mit adaptierten Aminosäuren- und Ketosäurengemischen. Therapiewoche 34:49–62
20.
Zurück zum Zitat Gerok W, Haeussinger D (1984) Ammonia detoxication and glutamine metabolism in severe liver disease and its role in the pathogenesis of hepatic encephalopathy. In: Haeussinger D, Sies H (eds) Glutamine Metabolism in Mammalian Tissues, Springer, Heidelberg Berlin New York Tokyo, pp. 257–277 Gerok W, Haeussinger D (1984) Ammonia detoxication and glutamine metabolism in severe liver disease and its role in the pathogenesis of hepatic encephalopathy. In: Haeussinger D, Sies H (eds) Glutamine Metabolism in Mammalian Tissues, Springer, Heidelberg Berlin New York Tokyo, pp. 257–277
21.
Zurück zum Zitat Gyr K, Meier R, Haussler J, Bouletreau P, Fleig WE, Gatta A, Holstege A (1996) Evaluation of the efficacy and safety of flumazenil in the treatment of portal systemic encephalopathy. Gut 39:319–324 Gyr K, Meier R, Haussler J, Bouletreau P, Fleig WE, Gatta A, Holstege A (1996) Evaluation of the efficacy and safety of flumazenil in the treatment of portal systemic encephalopathy. Gut 39:319–324
22.
Zurück zum Zitat Haeussinger D (1990) Nitrogen metabolism in liver: structural-functional organization and physiological implications. Biochem J 267:281–290 Haeussinger D (1990) Nitrogen metabolism in liver: structural-functional organization and physiological implications. Biochem J 267:281–290
23.
Zurück zum Zitat Haeussinger D, Gerok W (1995) Rückwirkungen von Lebererkrankungen auf das Zentralnervensystem: Hepatogene Enzephalopathie. In: Gerok W, Blum HE (eds) Hepatologie, 2nd edn. Urban & Schwarzenberg, München Wien Baltimore pp 845–859 Haeussinger D, Gerok W (1995) Rückwirkungen von Lebererkrankungen auf das Zentralnervensystem: Hepatogene Enzephalopathie. In: Gerok W, Blum HE (eds) Hepatologie, 2nd edn. Urban & Schwarzenberg, München Wien Baltimore pp 845–859
24.
Zurück zum Zitat Haeussinger D, Steeb R, Gerok W (1992) Metabolic alkalosis as driving force for urea synthesis in liver disease: pathogenetic model and therapeutic implications. Clin Investig 70(5): 411–415 Haeussinger D, Steeb R, Gerok W (1992) Metabolic alkalosis as driving force for urea synthesis in liver disease: pathogenetic model and therapeutic implications. Clin Investig 70(5): 411–415
25.
Zurück zum Zitat Kircheis G, Nilius R, Held C, Berndt H, Buchner M, Görtelmeyer R (1997) Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double blind study. Hepatology 25:1351–1360 Kircheis G, Nilius R, Held C, Berndt H, Buchner M, Görtelmeyer R (1997) Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double blind study. Hepatology 25:1351–1360
26.
Zurück zum Zitat Krieger D, Krieger S, Jansen O, Gass P, Theilmann L, Lichtnecker H (1995) Manganese and chronic hepatic encephalopathy. Lancet 346(8970): 270–274 Krieger D, Krieger S, Jansen O, Gass P, Theilmann L, Lichtnecker H (1995) Manganese and chronic hepatic encephalopathy. Lancet 346(8970): 270–274
27.
Zurück zum Zitat Kullmann F, Hollerbach S, Holstege A, Scholmerich J (1995) Subclinical hepatic encephalopathy: the diagnostic value of evoked potentials. J Hepatol 22(1): 101–110 Kullmann F, Hollerbach S, Holstege A, Scholmerich J (1995) Subclinical hepatic encephalopathy: the diagnostic value of evoked potentials. J Hepatol 22(1): 101–110
28.
Zurück zum Zitat Lang F, Hauessinger D (1990) Interaction of Cell Volume and Cell Function. Springer, Berlin Heidelberg New York Tokyo Lang F, Hauessinger D (1990) Interaction of Cell Volume and Cell Function. Springer, Berlin Heidelberg New York Tokyo
29.
Zurück zum Zitat Laubenberger J, Haussinger D, Bayer S, Gufler H, Hennig J, Langer M (1997) Proton magnetic resonance spectroscopy of the brain in symptomatic and asymptomatic patients with liver cirrhosis. Gastroenterology 112(5): 1610–1616 Laubenberger J, Haussinger D, Bayer S, Gufler H, Hennig J, Langer M (1997) Proton magnetic resonance spectroscopy of the brain in symptomatic and asymptomatic patients with liver cirrhosis. Gastroenterology 112(5): 1610–1616
30.
Zurück zum Zitat Lockwood AH (2002) Positron emission tomography in the study of hepatic encephalopathy. Metab Brain Dis 17(4): 431–435 Lockwood AH (2002) Positron emission tomography in the study of hepatic encephalopathy. Metab Brain Dis 17(4): 431–435
31.
Zurück zum Zitat Lockwood AH, Murphy BW, Donnelly KZ, Mahl TC, Perini S (1993) Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 18(5): 1061–1068 Lockwood AH, Murphy BW, Donnelly KZ, Mahl TC, Perini S (1993) Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 18(5): 1061–1068
32.
Zurück zum Zitat Lockwood AH, Yap EW, Rhoades HM, Wong WH (1991) Altered cerebral blood flow and glucose metabolism in patients with liver disease and minimal encephalopathy. J Cereb Blood Flow Metab 11(2): 331–336 Lockwood AH, Yap EW, Rhoades HM, Wong WH (1991) Altered cerebral blood flow and glucose metabolism in patients with liver disease and minimal encephalopathy. J Cereb Blood Flow Metab 11(2): 331–336
33.
Zurück zum Zitat Lockwood AH, Yap EW, Wong WH (1991) Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 11(2): 337–341 Lockwood AH, Yap EW, Wong WH (1991) Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 11(2): 337–341
34.
Zurück zum Zitat Mendenhall CL, Rouster S, Marshall L, Weesner R (1986) A new therapy for portal systemic encephalopathy. American J Gastroent 81:540–543. Mendenhall CL, Rouster S, Marshall L, Weesner R (1986) A new therapy for portal systemic encephalopathy. American J Gastroent 81:540–543.
35.
Zurück zum Zitat Morgan MY (1996) Noninvasive neuroinvestigation in liver disease. Semin Liver Dis 16(3): 293–314 Morgan MY (1996) Noninvasive neuroinvestigation in liver disease. Semin Liver Dis 16(3): 293–314
36.
Zurück zum Zitat Naylor CD, O´Rourkee K, Detsky AS, Baker JP (1989) Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy. A Meta-Analysis. Gastroenterology 97:1033–1042 Naylor CD, O´Rourkee K, Detsky AS, Baker JP (1989) Parenteral nutrition with branched-chain amino acids in hepatic encephalopathy. A Meta-Analysis. Gastroenterology 97:1033–1042
37.
Zurück zum Zitat O'Carroll RE, Hayes PC, Ebmeier KP et al. (1991) Regional cerebral blood flow and cognitive function in patients with chronic liver disease. Lancet 337(8752): 1250–1253 O'Carroll RE, Hayes PC, Ebmeier KP et al. (1991) Regional cerebral blood flow and cognitive function in patients with chronic liver disease. Lancet 337(8752): 1250–1253
38.
Zurück zum Zitat Plauth M, Egberts EH (1993) Was ist gesichert in der Therapie der hepatischen Enzephalopathie? Internist 34:35–42 Plauth M, Egberts EH (1993) Was ist gesichert in der Therapie der hepatischen Enzephalopathie? Internist 34:35–42
39.
Zurück zum Zitat Pomier Layrargues G (1996) TIPS and hepatic encephaloapthy. Semin Liver Dis 16:315–320 Pomier Layrargues G (1996) TIPS and hepatic encephaloapthy. Semin Liver Dis 16:315–320
40.
Zurück zum Zitat Pomier Layrargues G, Giguére JF, Lavoie J, Perney P, Gagnon S, D'Amour M (1994) Clinical efficacy of benzodiazepine antagonist RO 15–1788 (flumazenil) in cirrhotic patients with hepatic coma: results of a randomized double-blind placebo-controlled crossover trial. Hepatology 19:32–37 Pomier Layrargues G, Giguére JF, Lavoie J, Perney P, Gagnon S, D'Amour M (1994) Clinical efficacy of benzodiazepine antagonist RO 15–1788 (flumazenil) in cirrhotic patients with hepatic coma: results of a randomized double-blind placebo-controlled crossover trial. Hepatology 19:32–37
41.
Zurück zum Zitat Pomier Layrargues G, Spahr L, Butterworth RF (1995) Increased manganese concentrations in pallidum of cirrhotic patients. Lancet 345:735 Pomier Layrargues G, Spahr L, Butterworth RF (1995) Increased manganese concentrations in pallidum of cirrhotic patients. Lancet 345:735
42.
Zurück zum Zitat Pujol A, Pujol J, Graus F et al. (1993) Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology 43(1): 65–69 Pujol A, Pujol J, Graus F et al. (1993) Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology 43(1): 65–69
43.
Zurück zum Zitat Ross B, Kreis R, Farrow NA, Ackermann Z (1992) Metabolic disorders of the brain in chronic hepatic encephalopathy detected with H-1 MR spectroscopy. Radiology 182:19–27 Ross B, Kreis R, Farrow NA, Ackermann Z (1992) Metabolic disorders of the brain in chronic hepatic encephalopathy detected with H-1 MR spectroscopy. Radiology 182:19–27
44.
Zurück zum Zitat Sanyal AJ, Freedman AM, Shiffman ML, Purdum PP, Luketic VA, Cheatham AK (1994) Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunts: Results of a prospective controlled study. Hepatology 20:46–55 Sanyal AJ, Freedman AM, Shiffman ML, Purdum PP, Luketic VA, Cheatham AK (1994) Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunts: Results of a prospective controlled study. Hepatology 20:46–55
45.
Zurück zum Zitat Schomerus H, Schreiegg J (1993) Prevalence of latent portosystemic encephalopathy in an unselected population of patients with liver cirrhosis in general practice. Z Gastroent 31:231–234 Schomerus H, Schreiegg J (1993) Prevalence of latent portosystemic encephalopathy in an unselected population of patients with liver cirrhosis in general practice. Z Gastroent 31:231–234
46.
Zurück zum Zitat Sterns RH, Riggs JE, Schochet SS Jr (1986) Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 314(24): 1535–1542 Sterns RH, Riggs JE, Schochet SS Jr (1986) Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 314(24): 1535–1542
47.
Zurück zum Zitat Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA, de Sa ME (1992) Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology 39:542–545 Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA, de Sa ME (1992) Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology 39:542–545
48.
Zurück zum Zitat Sushma S, Dasarathy S, Tandon RK, Jain S, Gupta S, Bhist MS (1992) Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial. Hepatology 16:138–144 Sushma S, Dasarathy S, Tandon RK, Jain S, Gupta S, Bhist MS (1992) Sodium benzoate in the treatment of acute hepatic encephalopathy: a double-blind randomized trial. Hepatology 16:138–144
49.
Zurück zum Zitat Tangermann A (1991) The role of mercaptans in the pathogenesis of hepatic encephalopathy. In: Bengtsson F, Jeppsson B, Almdal T, Vilstrup H (eds) Progress in Hepatic Encephalopathy and Metabolic Nitrogen Exchange, CRC Press, Boca Raton, pp 259–270 Tangermann A (1991) The role of mercaptans in the pathogenesis of hepatic encephalopathy. In: Bengtsson F, Jeppsson B, Almdal T, Vilstrup H (eds) Progress in Hepatic Encephalopathy and Metabolic Nitrogen Exchange, CRC Press, Boca Raton, pp 259–270
50.
Zurück zum Zitat Tarao K, Ikeda T, Hayashi K, Sakurai A, Okada T, Ito T (1990) Successful use of vancomycin hydrochloride in the treatment of lactulose resistant chronic hepatic encephalopathy. Gut 31:702–706 Tarao K, Ikeda T, Hayashi K, Sakurai A, Okada T, Ito T (1990) Successful use of vancomycin hydrochloride in the treatment of lactulose resistant chronic hepatic encephalopathy. Gut 31:702–706
51.
Zurück zum Zitat Taylor-Robinson SD, Sargentoni J et al. (1994) Cerebral phosphorus-31 magnetic resonance spectroscopy in patients with chronic hepatic encephalopathy. Hepatology 20(5): 1173–1178 Taylor-Robinson SD, Sargentoni J et al. (1994) Cerebral phosphorus-31 magnetic resonance spectroscopy in patients with chronic hepatic encephalopathy. Hepatology 20(5): 1173–1178
52.
Zurück zum Zitat Taylor-Robinson SD, Sargentoni J, Marcus CD, Morgan MY, Bryant DJ (1994) Regional variations in cerebral proton spectroscopy in patients with chronic hepatic encephalopathy. Metab Brain Dis 9(4): 347–359 Taylor-Robinson SD, Sargentoni J, Marcus CD, Morgan MY, Bryant DJ (1994) Regional variations in cerebral proton spectroscopy in patients with chronic hepatic encephalopathy. Metab Brain Dis 9(4): 347–359
53.
Zurück zum Zitat Taylor-Robinson SD, Sargentoni J et al. (1996) MR imaging and spectroscopy of the basal ganglia in chronic liver disease: correlation of T1-weighted contrast measurements with abnormalities in proton and phosphorus-31 MR spectra. Metab Brain Dis 11(3): 249–268 Taylor-Robinson SD, Sargentoni J et al. (1996) MR imaging and spectroscopy of the basal ganglia in chronic liver disease: correlation of T1-weighted contrast measurements with abnormalities in proton and phosphorus-31 MR spectra. Metab Brain Dis 11(3): 249–268
54.
Zurück zum Zitat Timmermann L, Gross J, Dirks M, Volkmann J, Freund HJ, Schnitzler A (2003) The cerebral oscillatory network of parkinsonian resting tremor. Brain 126(Pt 1): 199–212 Timmermann L, Gross J, Dirks M, Volkmann J, Freund HJ, Schnitzler A (2003) The cerebral oscillatory network of parkinsonian resting tremor. Brain 126(Pt 1): 199–212
55.
Zurück zum Zitat Weissenborn K, Ehrenheim C, Hori A, Kubicka S, Manns MP (1995) Pallidal lesions in patients with liver cirrhosis: clinical and MRI evaluation. Metab Brain Dis 10(3): 219–231 Weissenborn K, Ehrenheim C, Hori A, Kubicka S, Manns MP (1995) Pallidal lesions in patients with liver cirrhosis: clinical and MRI evaluation. Metab Brain Dis 10(3): 219–231
56.
Zurück zum Zitat Zeneroli ML, Cioni G, Vezzelli C, Grandi S, Crisi G, Luzietti R, Ventura E (1987) Prevalence of brain atrophy in liver cirrhosis patients with chronic persistent encephalopathy. Evaluation by computed tomography. J Hepatol 4:283–292 Zeneroli ML, Cioni G, Vezzelli C, Grandi S, Crisi G, Luzietti R, Ventura E (1987) Prevalence of brain atrophy in liver cirrhosis patients with chronic persistent encephalopathy. Evaluation by computed tomography. J Hepatol 4:283–292
57.
Zurück zum Zitat Zieve FJ, Zieve L, Doizaki WM, Gilsdorf RB (1974) Synergism between ammonia and fatty acids in the production of coma: implications for hepatic coma. J Pharmacol Exp Ther 191(1): 10–16 Zieve FJ, Zieve L, Doizaki WM, Gilsdorf RB (1974) Synergism between ammonia and fatty acids in the production of coma: implications for hepatic coma. J Pharmacol Exp Ther 191(1): 10–16
58.
Zurück zum Zitat Zieve L, Doizaki WM, Zieve J (1974) Synergism between mercaptans and ammonia or fatty acids in the production of coma: a possible role for mercaptans in the pathogenesis of hepatic coma. J Lab Clin Med 83(1): 16–28 Zieve L, Doizaki WM, Zieve J (1974) Synergism between mercaptans and ammonia or fatty acids in the production of coma: a possible role for mercaptans in the pathogenesis of hepatic coma. J Lab Clin Med 83(1): 16–28
Metadaten
Titel
Hepatische Enzephalopathie
verfasst von
Priv.-Doz. Dr. P. D. Schellinger
M. K. Hartmann
Ch. Klingmann
H. M. Meinck
Publikationsdatum
01.12.2003
Verlag
Springer-Verlag
Erschienen in
Der Nervenarzt / Ausgabe 12/2003
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-003-1579-1

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