Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • COVID-19
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • Topics A-Z
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • COVID-19
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • Topics A-Z
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Author response: A meta-analysis of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy

  • Mark Danta, Hepatologist, St Vincent's Clinical School, Faculty of Medicine, UNSW (Sydney, Australia)
  • Sara Montagnese, Hepatologist, University of Padua (Padua, Italy)
Submitted January 18, 2020

We thank Dr. Gupta for the comment on our article.1 Hepatic encephalopathy (HE) is associated with significant morbidity and mortality in cirrhosis; its pathophysiology is incompletely understood. Our meta-analysis was a review of magnetic resonance spectroscopy (MRS) data in HE, which confirmed a specific metabolic pattern, consisting of increased glutamine/glutamate—with reduced choline—and myo-inositol, particularly in the parietal lobes.1 The changes increased with the severity of HE. We agree that this would have limited diagnostic utility in overt HE, which is clinically obvious. We strongly disagree, however, with regards to covert or minimal HE (CHE/MHE), which are defined as the presence of neuropsychological or neurophysiologic abnormalities in patients with no obvious—i.e., at least disorientation for time or asterixis—clinical signs of overt HE. Here there is a potential role for MRS in diagnosis, monitoring, and investigation. In a recent French cohort of cirrhotic individuals with and without MHE, HE pattern MRS changes in the pallidum were present in 95% of MHE versus 0% of unimpaired patients (p<0.001), suggesting MRS could outperform other modalities of MHE diagnosis.2 MRS may also have a significant role in future pathophysiological and pharmacological HE studies.

Disclosure

The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.

References

  1. Zeng G, Penninkilampi R, Chaganti J, et al. A meta-analysis of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy. Neurology 2020 Epub Jan 9.
  2. Hermann B, Rudler M, Galanaud D, Thabut D, Weiss N. Magnetic resonance spectroscopy: A surrogate marker of hepatic encephalopathy? J Hepatol 2019;71:1055–1057.

Navigate back to article

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • Neurology: Education
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2022 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise