What is asterixis?
👋Described~60 yrs ago by Adams/Foley
👋Methods:60pts w/impending hepatic coma vs controls
👋Flapping flexion/extension, best @ the🤚but happens even 2 the 👁️lids! Has intervening tremor (mini-asterixis)
Look 4 it while checking handgrip!
#livertwitter
1/4
👋Described~60 yrs ago by Adams/Foley
👋Methods:60pts w/impending hepatic coma vs controls
👋Flapping flexion/extension, best @ the🤚but happens even 2 the 👁️lids! Has intervening tremor (mini-asterixis)
Look 4 it while checking handgrip!
#livertwitter
1/4
Why asterixis?
1⃣Adams/Foley:🤷
2⃣Ammonia? Unlikely!(fig1)
3⃣Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)
4⃣They looked @🧠; swollen astrocytes! Particularly in the basal ganglia!(Fig3)
#livertwitter 2/4
1⃣Adams/Foley:🤷
2⃣Ammonia? Unlikely!(fig1)
3⃣Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)
4⃣They looked @🧠; swollen astrocytes! Particularly in the basal ganglia!(Fig3)
#livertwitter 2/4
Why asterixis part 2
A study using magnetoencephalography showed:
1⃣There is 'excessive corticomuscular motor coherence' 2⃣Diseased basal ganglia fail to select and pace the motor areas
This seems to confirm what Adams/Foley found in the brain
3/4
A study using magnetoencephalography showed:
1⃣There is 'excessive corticomuscular motor coherence' 2⃣Diseased basal ganglia fail to select and pace the motor areas
This seems to confirm what Adams/Foley found in the brain
3/4
But!
Asterixis can happen in non-cirrhotic patients!
1⃣Right after Adams/Foley paper, Conn found it in 🫁disease! (fig1)
2⃣Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)
3⃣Causes include any metabolic disturbance and meds(Figs 3-4)
4/4
Asterixis can happen in non-cirrhotic patients!
1⃣Right after Adams/Foley paper, Conn found it in 🫁disease! (fig1)
2⃣Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)
3⃣Causes include any metabolic disturbance and meds(Figs 3-4)
4/4
To review:
Asterixis has many causes
1️⃣metabolic disarray
2️⃣astrocyte swelling (likely from glutamine excess due to increased ammonia metabolism)
3️⃣meds meds meds
#livertwitter #cirrhosis
If you would like more references for the physiology of HE: mayoclinicproceedings.org
Asterixis has many causes
1️⃣metabolic disarray
2️⃣astrocyte swelling (likely from glutamine excess due to increased ammonia metabolism)
3️⃣meds meds meds
#livertwitter #cirrhosis
If you would like more references for the physiology of HE: mayoclinicproceedings.org
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