Management of Neurologic Manifestations in Patients with Liver Disease

Opinion statement Liver disease, both in its acute and chronic forms, can be associated with a wide spectrum of neurologic manifestations, both central and peripheral, ranging in severity from subclinical changes to neurocritical conditions. Neurologists are frequently consulted to participate in their management. In this review, we present an overview of management strategies for patients with hepatic disease whose clinical course is complicated by neurologic manifestations. Type A hepatic encephalopathy (HE), which occurs in acute liver failure, is a neurologic emergency, and multiple measures should be taken to prevent and treat cerebral edema. In Type C HE, which occurs in chronic liver disease, management should be aimed at correcting precipitant factors and hyperammonemia. There is an increasing spectrum of drug treatments available to minimize ammonia toxicity. Acquired hepatocerebral degeneration is a rare complication of the chronic form of HE, with typical clinical and brain MRI findings, whose most effective treatment is liver transplantation. Epilepsy is frequent and of multifactorial cause in patients with hepatic disease, and careful considerations should be made regarding choice of the appropriate anti-epileptic drugs. Several mechanisms increase the risk of stroke in hepatic disease, but many of the drugs used to treat and prevent stroke are contraindicated in severe hepatic failure. Hepatitis C infection increases the risk of ischemic stroke. Hemorr...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research

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This study aims, first, to validate a retrospectively-gated implementation of the DENSE method for assessing brain tissue pulsations as a physiological marker, and second, to use the acquired measurements to explore intracranial volume dynamics. We acquired repeated measurements of cerebral volumetric strain in 8 healthy subjects, and internally validated these measurements by comparing them to spinal CSF stroke volumes obtained in the same scan session.Peak volumetric strain was found to be highly repeatable between scan sessions. First/second measured peak volumetric strains were: (6.4 ± 1.7)x10−4/(6.7...
Source: NeuroImage - Category: Neuroscience Source Type: research
Publication date: January 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 1Author(s): Muhammad Aftab, T. Brett Reece, Lars G. Svensson
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsSarcopenia is prevalent in LTx patients. Neither sarcopenia nor 6MWD predicted mortality or short-term outcomes after LTx. This is in contrast to albumin levels, which were inversely associated with survival and complications. Albumin shows promise as an important predictor of mortality and short-term outcomes after LTx.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
This study examined whether LVAD exchanges affect posttransplantation outcomes.MethodsThis study focused on adult patients in the Organ Procurement and Transplantation Network database who were bridged to transplant with a LVAD implanted between 2007 and 2017. Patients who underwent LVAD exchange were compared with those supported with a single device. The primary end point was all-cause mortality at 1, 2, and 5 years after transplantation. The impact of device exchange on risk-adjusted outcomes was examined using Cox proportional hazards models.ResultsAmong 8239 patients who met the inclusion criteria, there were 611 pump...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsWe established a novel formula to mathematically calculate actual 3D angles between inflow cannula and device body of HeartMate II. The formula would help investigators to validate their findings of the relationship between 2D projected angle (from CXR) and device thrombosis.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Publication date: January 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 1Author(s): Mostafa R. Amer, Wassim Mosleh, Saurabh Joshi, Jeffery F. Mather, Wael El-Mallah, Mohiuddin Cheema, Raymond G. McKayBackgroundPrevious reports described successful use of transcarotid and transsubclavian approaches for the performance of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who cannot be treated with transfemoral access. The purpose of the present study was to compare these two alternative approaches with respect to safety, efficacy, and procedural efficiency.MethodsA retrospe...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Publication date: January 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 1Author(s): J. Hunter Mehaffey, Robert B. Hawkins, Eric J. Charles, Irving L. Kron, Gorav Ailawadi, John A. Kern, Mark E. Roeser, Benjamin Kozower, Nicholas R. TemanBackgroundCurrent reporting on cardiac surgical outcomes focuses on a patient’s status at 30 days and lacks long-term meaningful data. The purpose of this study was to determine the impact of complications after cardiac operation on patient-reported outcomes (PROs) at 1 year after surgery.MethodsAll patients undergoing cardiac operation at an academic institution (2014...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Publication date: January 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 1Author(s): Elisabetta Lapenna, Michele De Bonis, Ilaria Giambuzzi, Benedetto Del Forno, Stefania Ruggeri, Manuela Cireddu, Simone Gulletta, Alessandro Castiglioni, Ottavio Alfieri, Paolo Della Bella, Stefano BenussiBackgroundThe study sought to assess the long-term outcomes of the stand-alone Cox-Maze IV procedure in symptomatic patients with refractory, persistent, or long-standing persistent atrial fibrillation (AF).MethodsFifty-nine consecutive patients (mean age 52 ± 10.5 years, previous catheter ablation 80%, left ventricul...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Authors: Baer A, Fagalde MS, Drake CD, Sohlberg EH, Barash E, Glick S, Millman AJ, Duchin JS Abstract INTRODUCTION: With the goal of eliminating hepatitis C virus (HCV) as a public health problem in Washington State, Public Health-Seattle &King County (PHSKC) designed a Hepatitis C Virus Test and Cure (HCV-TAC) data system to integrate surveillance, clinical, and laboratory data into a comprehensive database. The intent of the system was to promote identification, treatment, and cure of HCV-infected persons (ie, HCV care cascade) using a population health approach. MATERIALS AND METHODS: The data system aut...
Source: Public Health Reports - Category: International Medicine & Public Health Tags: Public Health Rep Source Type: research
Authors: Twumasi C, Asiedu L, Nortey ENN Abstract Several mathematical and standard epidemiological models have been proposed in studying infectious disease dynamics. These models help to understand the spread of disease infections. However, most of these models are not able to estimate other relevant disease metrics such as probability of first infection and recovery as well as the expected time to infection and recovery for both susceptible and infected individuals. That is, most of the standard epidemiological models used in estimating transition probabilities (TPs) are not able to generalize the transition esti...
Source: Interdisciplinary Perspectives on Infectious Diseases - Category: Infectious Diseases Tags: Interdiscip Perspect Infect Dis Source Type: research
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