الفهرس 
Anatomy & PhysiologyOnly 14 pages are availabe for public view
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Abstract
The liver is the largest internal organ of the body. The liver performs many functions. These essential functions are impaired when a liver develops cirrhosis. Estimated cirrhosis mortality is between 34 - 66%, largely dependent on the cause of the cirrhosis; alcoholic cirrhosis has a worse prognosis than primary biliary cirrhosis and cirrhosis due to viral hepatitis.
Liver cirrhosis increases resistance to blood flow and higher pressure in the portal venous system, resulting in portal hypertension. Portal hypertension leads usually to variceal formation and emergence of shunts between portal and systemic circulation, which are accused to be the main reason for extrapyramidal symptoms.
Hepatic encephalopathy is a syndrome of neurological and psychiatric disturbances considered as a hallmark of acute hepatic failure. Hepatic encephalopathy in cirrhotic patients progresses from sleep disturbances and slight attention deficits to disorientation, disturbed consciousness and perhaps coma over time periods ranging from several days up to months. Patients with acute liver failure may present with altered behavior even before the first clinical signs of altered liver function are present.
A minority of patients with chronic liver disease develop acquired form of hepatocerebral degeneration. This is attributed to prolonged exposure to metabolic toxins that cause encephalopathy, especially manganese. Dementia, dysarthria, cerebellar dysfunction, movement disorders, rigidity and myelopathy have all been reported. Hepatocerebral degeneration includes acquired and familial causes; both can have similar clinical presentations. In the inherited form there is a metabolic dysfunction which leads to copper deposition in neurons. Consequently, the disease causes Parkinsonism, dystonia, and abnormal movements that include athetosis and chorea. In the acquired form, akinetic-rigid symptoms were prevalent and are caused mainly by manganese deposition in neurons. Recent neuroradiological imaging studies mainly brain MRI; have shown hyperintense signals in various brain regions on T1 weighted images.
The current study aimed to determine the prevalence of extrapyramidal signs in chronic liver disease patients. As to our knowledge, there is no available data about the prevalence of extrapyramidal signs in chronic liver disease patients in Egypt.
All patients admitted in El-Demerdash Hospital, Department of Tropical Medicine were asked to participate in the study. Five months were included in this study; starting from August 2014 – November 2014. 53 patients were excluded. The total number of patients included all over the five months was 118 patients. The age of the patients ranged from 20 to 76 years, with mean age of 53.29 years old.
Data related to the diagnosis of chronic liver disease and its complications were collected. That included laboratory investigations, imaging studies and screening neurological examination and assessment that was done by the main researcher and audited by a senior staff member, Dr. Ahmed Gaber, Professor of Neurology, Ain Shams University, to assess the patients for extrapyramidal signs.