Pathophysiology of cerebral oedema in acute liver failure
Pathophysiology of cerebral oedema in acute liver failure作者机构：Institute of Liver Studies King’s College London School of Medicine at King’s College Hospital King’s College Hospital London SE5 9RS United Kingdom
出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)
年 卷 期：2013年第19卷第48期
页 面：9240-9255页
核心收录：
学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学]
基 金：Supported by Medical Research Council(MRC)Centre for Transplantation,King’s College London,United Kingdom-MRC grant No.MR/J006742/1 The National Institute for Health Research(NIHR)Biomedical Research Centre based at Guy’s and St Thomas’NHS Foundation Trust and King’s College London
主 题：Cerebral oedema Acute liver failure Ammonia Hepatic encephalopathy Intracranial pressure Intracranial hypertension Cerebral blood flow
摘 要：Cerebral oedema is a devastating consequence of acute liver failure(ALF)and may be associated with the development of intracranial hypertension and *** ALF,some patients may develop cerebral oedema and increased intracranial pressure but progression to lifethreatening intracranial hypertension is less frequent than previously described,complicating less than one third of cases who have proceeded to coma since the advent of improved clinical *** rapid onset of encephalopathy may be dramatic with the development of asterixis,delirium,seizures and *** and vasogenic oedema mechanisms have been implicated with a preponderance of experimental data favouring a cytotoxic *** swelling is the most consistent neuropathological finding in humans with ALF and ammonia plays a definitive role in the development of cytotoxic brain *** mechanism(s)by which ammonia induces astrocyte swelling remains unclear but glutamine accumulation within astrocytes has led to the osmolyte *** evidence also supports an alternate‘Trojan horse’hypothesis,with glutamine as a carrier of ammonia into mitochondria,where its accumulation results in oxidative stress,energy failure and ultimately astrocyte *** a complete breakdown of the blood-brain barrier is not evident in human ALF,increased permeation to water and other small molecules such as ammonia has been demonstrated resulting from subtle alterations in the protein composition of paracellular tight *** present,there is no fully efficacious therapy for cerebral oedema other than liver transplantation and this reflects our incomplete knowledge of the precise mechanisms underlying this process which remain largely unknown.
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