Multimodal Neurological Evaluation of Patients with Hepatic Cirrhosis

Sub-clinical cases of hepatic encephalopathy (HE) affect more than half of patients with hepatic cirrhosis (HC). The trigeminal-facial reflex (TFR) is an accessible method which may be helpful in those cases. To investigate brain structure of patients with HC without signs of HE using TFR and quantitative neuroimaging. After obtained patient and Institutional Review Board approval, 21 patients (10 women, 58 ± 10 years) and 21 controls (12 women, 43 ± 9 years) were recruited. Patients were submitted to TFR analysis, EEG and 3T MRI on the same day. 3D T1 volumetric images were used for voxel-based morphometry performed with SPM12. Statistical analysis comparing patients versus controls and regression analysis was made between the brain volumes and the parameters obtained in the TFR using the general linear model with significance level of p <0.05 corrected for multiple comparisons. EEG was normal for all patients. Areas of atrophy were detected in patients with HE, 151907 mm3 for the gray matter and 32330 mm3 for white matter. Negative correlations between brain volumes and latency of left R2i (1702 mm3, superior parietal lobule), right (5844 mm3, medial orbital and fusiform gyrus) and left R2c (4329 mm3, hippocampus and medial orbital gyrus) were observed. Patients without clinical or EEG signs of HE showed brain atrophy. The values obtained by TFR were inversely corelated to brain volume (the higher the latencies, the smaller the amount of brain tissue). RTF may be an easy and interesting method for evaluating minimal hepatic encephalopathy.