Cirrhosis (CNS manifestations)

There are several central nervous system complications that can arise in the setting of cirrhosis, which can be classified as those which are general (essentially hepatic encephalopathy) and those that are specific to the cause of cirrhosis.

General manifestations

The major manifestation is hepatic encephalopathy which can be subdivided into:

• acute hepatic encephalopathy which is a rare syndrome due to hyperammonemia and is potentially reversible, and
• chronic hepatic encephalopathy which is far more common and secondary to cirrhosis

Disease-specific manifestations

• alcoholic cirrhosis
  • osmotic demyelination syndrome (central pontine myelinolysis) due to altered sodium levels
  • Wernicke encephalopathy due to thiamine deficiency
  • Marchiafava–Bignami disease due to deficiency in multiple B group vitamins resulting in demyelination of the corpus callosum
  • alcohol-related dementia
• Wilson disease causes siderosis
• hemochromatosis causes hypopituitarism and parkinsonism