HEPATIC NEUROPATHY

Abstract

The peripheral nerve function was affected in 31 out of 34 patients with severe chronic hepatic failure, 20 of whom had a surgical portacaval shunt. Clinical findings were confined to the legs, an elevated vibratory perception threshold (VPT) on the big toe being the most common sign. However, the nerve function in the arm was also impaired. During ischaemia the rise in VPT (index finger) was delayed in 18 patients. An equivalent slowing of the sensory nerve conduction velocity was recorded in the digit-wrist and the wrist-elbow segments of the median nerve, accompanied by a reduction in amplitude and an increase in temporal dispersion of the action potentials. The sensory threshold for electrical stimuli (digit 3) was significantly raised. The frequency of neurological findings suggests that a peripheral nerve dysfunction is an integral part of the severe chronic hepatic failure syndrome. There was no relation to the routine liver function tests or to the galactose elimination capacity, a measure of the functioning liver mass. Neurological findings occurred with the same frequency in patients with and without chronic alcoholism or a diabetic glucose tolerance test. From the distribution of findings it is suggested that hepatic neuropathy results from a metabolic inhibition of the nerve axon membrane function.