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Metab Brain Dis. 2016 Dec;31(6):1249-1258. Epub 2016 Jun 7.

Brain edema: a valid endpoint for measuring hepatic encephalopathy?

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Département de nutrition, Université de Montréal, Montréal, Québec, Canada.
Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, Montréal, Québec, Canada.
Centre d'Imagerie Biomédicale (CIBM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
Department of Medicine V (Hepatology and Gastroenterology), Aarhus, Denmark.
Department of Ophthalmology, Haukeland University Hospital, 5012, Bergen, Norway.
Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, 14642, USA.
Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York, 10595, USA.
Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, Montréal, Québec, Canada.


Hepatic encephalopathy (HE) is a major complication of liver failure/disease which frequently develops during the progression of end-stage liver disease. This metabolic neuropsychiatric syndrome involves a spectrum of symptoms, including cognition impairment, attention deficits and motor dysfunction which eventually can progress to coma and death. Pathologically, HE is characterized by swelling of the astrocytes which consequently leads to brain edema, a common feature found in patients with acute liver failure (ALF) as well as in cirrhotic patients suffering from HE. The pathogenic factors involved in the onset of astrocyte swelling and brain edema in HE are unresolved. However, the role of astrocyte swelling/brain edema in the development of HE remains ambiguous and therefore measuring brain edema as an endpoint to evaluate HE is questioned. The following review will determine the effect of astrocyte swelling and brain edema on neurological function, discuss the various possible techniques to measure brain edema and lastly to propose a number of neurobehavioral tests to evaluate HE.


Astrocyte; Brain edema; Hepatic encephalopathy; Magnetic resonance imaging; Neurobehavior

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