Neuropsychiatric implications of brain tryptophan perturbations appearing in hepatic encephalopathy.

Abstract

The metabolic encephalopathies exhibit CNS-symptoms that rapidly may alter in location of brain region of engagement, indicating a continuous fluctuation of the level of which brain functions are disturbed. This is particularly obvious in chronic conditions, such as chronic or latent hepatic encephalopathy (HE), where the fluctuating level of consciousness may be a dangerous sudden developing symptom in a person otherwise appearing to have normal brain functions. If these individuals are occupied with e.g. driving vehicle in traffic or working in heavy industrial practice, such chronic portal-systemic encephalopathy (PSE) (Sherlock et al., 1954) may be a particular hazard to both themselves and others. Unfortunately, the pathogenesis of PSE is still unknown. Hence, the delineation of the pathogenesis for HE/PSE, and therapeutic modalities developing therefrom, is highly warrented. Numerous pathogenetic mechanisms and etiological factors for PSE have been suggested (Conn and Liebertahl, 1979).