Abstract

Hepatic encephalopathy shows very distinct clinical features combining cognitive dysfunction, alterations of consciousness and motor symptoms indicating an alteration of the extrapyramidal and cerebellar motor system and the pyramidal tract. Positron emission tomography studies of the cerebral glucose utilisation in patients with liver cirrhosis and various grades of hepatic encephalopathy show accordingly alterations in distinct brain areas – a decrease of the glucose utilisation especially in the frontal cortex and anterior cingulated gyrus, and an increase in the hippocampus, basal ganglia and cerebellum. These alterations in cerebral glucose utilisation correlate significantly with psychometric test results and brain metabolite alterations as measured by magnetic resonance spectroscopy.