Aa
hepatitis c
I Hi There, Could sure use your help, I have know idea what this means, do you think i should have a fallow up ? > MRI BRAIN WITH AND WITHOUT CONTRAST, 07/02/12 15:57:00.
I had the mri, because i cant stay focussed, i feel out of it. and sleep all the time. i also have a deveated spec at night one side of my airway is blocked. also I have VERY bad blood circulation, and enemea in the legs. I cant seem to get answers, so anything you can share or direction you can send me, i cant tell you how much i would appreciate it. IM 53 female
TECHNIQUE: Multiplanar, multi-sequence MR imaging of the entire brain
was performed without and with 16 cc Omniscan intravenous gadolinium
contrast.
FINDINGS:
There is bilateral T1 hyperintensity involving both globus pallidi
and internal capsules, given history of cirrhosis which is consistent
with hepatic encephalopathy. Focus of T2 hyperintensities with
susceptibility artifact involving globus pallidi is likely secondary
to basal ganglia calcifications. Otherwise cerebral and cerebellar
hemispheres are normal in appearance and signal intensity. There are
scattered periventricular FLAIR hyper intensities, consistent with
periventricular small vessel ischemic changes. The ventricles are
normal in size. The basilar cisterns are maintained. There is no
evidence of intra-axial or extra-axial hemorrhage, or mass. No
abnormal enhancing foci are identified. There is incidental finding
of right cerebellar venous anomaly. Small amount of secretion is
noted into left sphenoid sinus.
I had the mri, because i cant stay focussed, i feel out of it. and sleep all the time. i also have a deveated spec at night one side of my airway is blocked. also I have VERY bad blood circulation, and enemea in the legs. I cant seem to get answers, so anything you can share or direction you can send me, i cant tell you how much i would appreciate it. IM 53 female
TECHNIQUE: Multiplanar, multi-sequence MR imaging of the entire brain
was performed without and with 16 cc Omniscan intravenous gadolinium
contrast.
FINDINGS:
There is bilateral T1 hyperintensity involving both globus pallidi
and internal capsules, given history of cirrhosis which is consistent
with hepatic encephalopathy. Focus of T2 hyperintensities with
susceptibility artifact involving globus pallidi is likely secondary
to basal ganglia calcifications. Otherwise cerebral and cerebellar
hemispheres are normal in appearance and signal intensity. There are
scattered periventricular FLAIR hyper intensities, consistent with
periventricular small vessel ischemic changes. The ventricles are
normal in size. The basilar cisterns are maintained. There is no
evidence of intra-axial or extra-axial hemorrhage, or mass. No
abnormal enhancing foci are identified. There is incidental finding
of right cerebellar venous anomaly. Small amount of secretion is
noted into left sphenoid sinus.
COMMUNITY LEADER
Thanks Nan! You are correct. The doctor was just covering all bases to make sure it wasn't caused caused by a neurological abnormality.
Here is some more info on Hepatic Encephalopathy
Things you can do now before your appointment at a Transplant Center:
* Do NOT eat red meat. Read meat produces lots of toxins making HE worse. It is okay to eat chicken and cooked fish for protein.
* Stay hydrated. Drink plenty of water.
* If you become constipated. Take a laxative. Constipation allow the toxins to build in you gut and can be dangerous.
* Liver patients have to be very careful with benzodiazepines (such as Valium) because benzodiazepines can trigger encephalopathy to get worse.
Encephalopathy (mental changes, coordination changes, sleeping changes) that can lead to coma
Encephalopathy can be caused by many things: a build-up of toxins (especially ammonia), drugs, alcohol, electrolyte disturbances, infections, internal bleeding, excess protein in the diet (especially red meat), constipation, dehydration, etc.
Treatment:
* Lactulose (a prescription liquid laxative that binds with ammonia and removes it from the body)
* Avoid alcohol, get an approval on any drugs (even over-the-counter medications or supplements)
* Have bloodtests done on a regular basis (to monitor electrolytes, CBC, etc.)
* Call the doctor if you see any signs of encephalopathy worsening)
* Go to the Emergency Room if it's really bad
-----------------------------------------------------------------------------------
Encephalopathy is a general name for brain dysfunction, which may be cause by factors including infectious diseases and toxins.
This condition occurs when a heavily damaged liver is unable to filter toxins from the blood or when blood flow through the liver is blocked. The condition may occur in people with either acute fulminant hepatitis or long-term chronic liver disease. Few patients with chronic hepatitis C develop full-blown hepatic encephalopathy; however, some degree of brain impairment may occur in as many as three-quarters of those who develop advanced liver cirrhosis.
The liver carries out many important bodily functions including filtering toxic metabolic byproducts from the blood. Normally blood coming from the intestines flows through the liver, where it undergoes detoxification. In people with decompensated cirrhosis—when the damaged liver is unable to carry out its normal metabolic processes or when blood bypasses the liver—these toxins can build up in the bloodstream.
High levels of toxins can affect the central nervous system (the brain and spinal cord), although how they do so is not well understood. Increased levels of ammonia are believed to be most responsible for hepatic encephalopathy. Ammonia is a byproduct of the digestion of proteins by bacteria in the intestines; normally ammonia is metabolized into urea by the liver and excreted by the kidneys as urine. High levels of ammonia appear to alter the balance of neurotransmitters (chemicals that carry messages between neurons) in the brain.
The severity of hepatic encephalopathy is measured on a five-point scale.
Grade 0 is indicated by minimal changes in memory, concentration, intellectual function, and coordination.
Grade 1 is characterized by increasing confusion and disorientation, forgetfulness, impaired intellectual function, decreased attention, agitation, lack of coordination, and disturbed sleep patterns (often day-night reversal).
Grade 2 involves drowsiness, disorientation, loss of ability to perform mental tasks, personality and behavior changes, and increased motor symptoms such as asterixis.
Grade 3 is characterized by lethargy, somnolence (sleeping), loss of mental function, profound confusion, amnesia, aggression, asterixis, and hyperactive reflexes.
Grade 4 is indicated by coma. In the coma stage, respiratory or cardiovascular failure may occur.
Symptomatic hepatic encephalopathy indicates serious liver disease and may be accompanied by other signs of decompensated cirrhosis such as jaundice, ascites, bleeding varices, and gynecomastia (enlarged breasts in men). Patients with acute, fulminant liver failure often have life-threatening brain swelling (cerebral edema), but this does not usually occur in people with encephalopathy due to chronic hepatitis.
Hepatic encephalopathy is diagnosed on the basis of clinical symptoms. Subclinical encephalopathy may be detected by neurological testing before the patient notices any symptoms. Family and friends may report mental or personality changes before the patients is aware of them. Elevated blood ammonia is common in people with hepatic encephalopathy, but ammonia level is not well correlated with severity of symptoms. Some people have a characteristic sweet, musty breath odor called fetor hepaticus. In the later stages, patients typically exhibit brain wave changes as measured by an EEG. Positron emission tomography (PET), CT scans, magnetic resonance imagery, and spinal taps may also be used to assist diagnosis. Many of the symptoms of hepatic encephalopathy also occur in people with other types of brain disease or damage (for example, meningitis, alcohol or drug overdose, stroke, head trauma), so doctors should be careful to rule out other possible causes.
Cheers!
Hector
Here is some more info on Hepatic Encephalopathy
Things you can do now before your appointment at a Transplant Center:
* Do NOT eat red meat. Read meat produces lots of toxins making HE worse. It is okay to eat chicken and cooked fish for protein.
* Stay hydrated. Drink plenty of water.
* If you become constipated. Take a laxative. Constipation allow the toxins to build in you gut and can be dangerous.
* Liver patients have to be very careful with benzodiazepines (such as Valium) because benzodiazepines can trigger encephalopathy to get worse.
Encephalopathy (mental changes, coordination changes, sleeping changes) that can lead to coma
Encephalopathy can be caused by many things: a build-up of toxins (especially ammonia), drugs, alcohol, electrolyte disturbances, infections, internal bleeding, excess protein in the diet (especially red meat), constipation, dehydration, etc.
Treatment:
* Lactulose (a prescription liquid laxative that binds with ammonia and removes it from the body)
* Avoid alcohol, get an approval on any drugs (even over-the-counter medications or supplements)
* Have bloodtests done on a regular basis (to monitor electrolytes, CBC, etc.)
* Call the doctor if you see any signs of encephalopathy worsening)
* Go to the Emergency Room if it's really bad
-----------------------------------------------------------------------------------
Encephalopathy is a general name for brain dysfunction, which may be cause by factors including infectious diseases and toxins.
This condition occurs when a heavily damaged liver is unable to filter toxins from the blood or when blood flow through the liver is blocked. The condition may occur in people with either acute fulminant hepatitis or long-term chronic liver disease. Few patients with chronic hepatitis C develop full-blown hepatic encephalopathy; however, some degree of brain impairment may occur in as many as three-quarters of those who develop advanced liver cirrhosis.
The liver carries out many important bodily functions including filtering toxic metabolic byproducts from the blood. Normally blood coming from the intestines flows through the liver, where it undergoes detoxification. In people with decompensated cirrhosis—when the damaged liver is unable to carry out its normal metabolic processes or when blood bypasses the liver—these toxins can build up in the bloodstream.
High levels of toxins can affect the central nervous system (the brain and spinal cord), although how they do so is not well understood. Increased levels of ammonia are believed to be most responsible for hepatic encephalopathy. Ammonia is a byproduct of the digestion of proteins by bacteria in the intestines; normally ammonia is metabolized into urea by the liver and excreted by the kidneys as urine. High levels of ammonia appear to alter the balance of neurotransmitters (chemicals that carry messages between neurons) in the brain.
The severity of hepatic encephalopathy is measured on a five-point scale.
Grade 0 is indicated by minimal changes in memory, concentration, intellectual function, and coordination.
Grade 1 is characterized by increasing confusion and disorientation, forgetfulness, impaired intellectual function, decreased attention, agitation, lack of coordination, and disturbed sleep patterns (often day-night reversal).
Grade 2 involves drowsiness, disorientation, loss of ability to perform mental tasks, personality and behavior changes, and increased motor symptoms such as asterixis.
Grade 3 is characterized by lethargy, somnolence (sleeping), loss of mental function, profound confusion, amnesia, aggression, asterixis, and hyperactive reflexes.
Grade 4 is indicated by coma. In the coma stage, respiratory or cardiovascular failure may occur.
Symptomatic hepatic encephalopathy indicates serious liver disease and may be accompanied by other signs of decompensated cirrhosis such as jaundice, ascites, bleeding varices, and gynecomastia (enlarged breasts in men). Patients with acute, fulminant liver failure often have life-threatening brain swelling (cerebral edema), but this does not usually occur in people with encephalopathy due to chronic hepatitis.
Hepatic encephalopathy is diagnosed on the basis of clinical symptoms. Subclinical encephalopathy may be detected by neurological testing before the patient notices any symptoms. Family and friends may report mental or personality changes before the patients is aware of them. Elevated blood ammonia is common in people with hepatic encephalopathy, but ammonia level is not well correlated with severity of symptoms. Some people have a characteristic sweet, musty breath odor called fetor hepaticus. In the later stages, patients typically exhibit brain wave changes as measured by an EEG. Positron emission tomography (PET), CT scans, magnetic resonance imagery, and spinal taps may also be used to assist diagnosis. Many of the symptoms of hepatic encephalopathy also occur in people with other types of brain disease or damage (for example, meningitis, alcohol or drug overdose, stroke, head trauma), so doctors should be careful to rule out other possible causes.
Cheers!
Hector
Wonderful response, Hector. I couldn't have responded any better.
My husband had all of the above symptoms with his hepatic encephalopathy.
From a caregiver's point of view, it is probably the worst part of caring for someone who has advanced liver disease.
My guess on why they did the brain MRI is they wanted to make sure nothing else was going on. The good news of the report is:
"There is no evidence of intra-axial or extra-axial hemorrhage, or mass. No
abnormal enhancing foci are identified."
That is not to minimize the hepatic encephalopathy you have. As Hector said, you need to see a hepatologist asap (if you are not seeing one as yet). Lactulose (special liquid laxative) will likely be prescribed to help you eliminate the excess toxins/ammonia from your body which is causing the confusion you are feeling as well as some of the other symptoms. There is also other medication in tablet form they may prescribe to help with it but you really needs to watch out for side effects.
I hope you get the help you need as soon as possible. I know first hand what you are experiencing and you need help now!
All the best,
Nan
My husband had all of the above symptoms with his hepatic encephalopathy.
From a caregiver's point of view, it is probably the worst part of caring for someone who has advanced liver disease.
My guess on why they did the brain MRI is they wanted to make sure nothing else was going on. The good news of the report is:
"There is no evidence of intra-axial or extra-axial hemorrhage, or mass. No
abnormal enhancing foci are identified."
That is not to minimize the hepatic encephalopathy you have. As Hector said, you need to see a hepatologist asap (if you are not seeing one as yet). Lactulose (special liquid laxative) will likely be prescribed to help you eliminate the excess toxins/ammonia from your body which is causing the confusion you are feeling as well as some of the other symptoms. There is also other medication in tablet form they may prescribe to help with it but you really needs to watch out for side effects.
I hope you get the help you need as soon as possible. I know first hand what you are experiencing and you need help now!
All the best,
Nan
COMMUNITY LEADER
What type of doctor suggested this MRI?
Do you have hepatitis C?
Have you had an ultrasound, CT scan or MRI of the abdomen?
Do you know of any lab blood tests result you have?
Has your doctor mentioned anything about a high Ammonia level?
The "Findings" from the MRI indicate you have a history of liver cirrhosis and hepatic encephalopathy.
Cirrhosis is the replacement of liver tissue by fibrosis, scar tissue and regenerative nodules. Cirrhosis usually takes many decades to develop. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver disease, but has many other possible causes.
"i cant stay focussed, i feel out of it. and sleep all the time."
This is a common complication of advanced cirrhosis of the liver.
It can also manifest itself as poor memory, confusion, reversal of day and night (trouble sleeping), get lost in familiar places, feeling drunk, stupor and coma as a result of liver failure.
----------------------------------------------------------------------------------------------
Hepatic Encephalopathy paper written by hepatologist Tim Davern, M.D.
"With more advanced hepatic encephalopathy, fatigue, and at least mild deficits of memory, concentration, and coordination may become apparent. At this stage, common complaints by the patient include:
- “I feel like my head is in the clouds.”
- “I’ll walk into a room and forget why I am there.”
- “I am always tired…but I can’t sleep.”
- “I often forget what to say in mid-sentence.”
- “My boss is telling me that my work is slipping.”
- “My handwriting has changed to scribble,”
- “My hands shake so much, I can’t hold my coffee cup without spilling it.”
Nighttime insomnia is a very common and troublesome symptom associated with hepatic encephalopathy. In fact, patients with encephalopathy may ultimately sleep more during the day, with fitful naps, than at night, and this “day-night reversal” is a hallmark of more advanced hepatic encephalopathy. Family and friends frequently notice a deterioration of the patient’s cognitive function as well as a change in the patient’s personality—with frequent irritability, bouts of anger, and loss of social graces. They may also witness firsthand deterioration of the patient’s driving skills (“He would have run off the road if I hadn’t grabbed the wheel!”)".
------------------------------------------------------------------------------------------
Having advanced cirrhosis and hepatic encephalopathy is a very serious disease. You could go into a coma while you are sleeping and not know it. If you live alone that is very, very dangerous! You need to to get treated for your condition. There are medicines that will help you manage your symptoms and feel much better. I have the same disease and symptoms as yourself so I know from personal experience.
***************************************************************************
The MOST IMPORTANT THING YOU CAN DO right now is be seen and treated at a Liver Transplant Center. They treat people with cirrhosis and hepatic encephalopathy every day.The sooner you see a hepatologist there the sooner you will feel better.
Get a referral from your doctor to get an appointment at the nearest Liver Transplant Center to where you live ASAP.
****************************************************************************
If you could post more information about any other symptoms you have having that would be helpful.
Do you feel fatigued all the time. No matter how much you sleep?
Are you losing weight?
Do your low legs, ankles or foot appear to be swollen? Does your abdomen swell?
Have you ever coughed or vomited blood?
If you provide your location we can probably help you find a transplant center.
Hang in there you will get the help you need.
Hector
Do you have hepatitis C?
Have you had an ultrasound, CT scan or MRI of the abdomen?
Do you know of any lab blood tests result you have?
Has your doctor mentioned anything about a high Ammonia level?
The "Findings" from the MRI indicate you have a history of liver cirrhosis and hepatic encephalopathy.
Cirrhosis is the replacement of liver tissue by fibrosis, scar tissue and regenerative nodules. Cirrhosis usually takes many decades to develop. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver disease, but has many other possible causes.
"i cant stay focussed, i feel out of it. and sleep all the time."
This is a common complication of advanced cirrhosis of the liver.
It can also manifest itself as poor memory, confusion, reversal of day and night (trouble sleeping), get lost in familiar places, feeling drunk, stupor and coma as a result of liver failure.
----------------------------------------------------------------------------------------------
Hepatic Encephalopathy paper written by hepatologist Tim Davern, M.D.
"With more advanced hepatic encephalopathy, fatigue, and at least mild deficits of memory, concentration, and coordination may become apparent. At this stage, common complaints by the patient include:
- “I feel like my head is in the clouds.”
- “I’ll walk into a room and forget why I am there.”
- “I am always tired…but I can’t sleep.”
- “I often forget what to say in mid-sentence.”
- “My boss is telling me that my work is slipping.”
- “My handwriting has changed to scribble,”
- “My hands shake so much, I can’t hold my coffee cup without spilling it.”
Nighttime insomnia is a very common and troublesome symptom associated with hepatic encephalopathy. In fact, patients with encephalopathy may ultimately sleep more during the day, with fitful naps, than at night, and this “day-night reversal” is a hallmark of more advanced hepatic encephalopathy. Family and friends frequently notice a deterioration of the patient’s cognitive function as well as a change in the patient’s personality—with frequent irritability, bouts of anger, and loss of social graces. They may also witness firsthand deterioration of the patient’s driving skills (“He would have run off the road if I hadn’t grabbed the wheel!”)".
------------------------------------------------------------------------------------------
Having advanced cirrhosis and hepatic encephalopathy is a very serious disease. You could go into a coma while you are sleeping and not know it. If you live alone that is very, very dangerous! You need to to get treated for your condition. There are medicines that will help you manage your symptoms and feel much better. I have the same disease and symptoms as yourself so I know from personal experience.
***************************************************************************
The MOST IMPORTANT THING YOU CAN DO right now is be seen and treated at a Liver Transplant Center. They treat people with cirrhosis and hepatic encephalopathy every day.The sooner you see a hepatologist there the sooner you will feel better.
Get a referral from your doctor to get an appointment at the nearest Liver Transplant Center to where you live ASAP.
****************************************************************************
If you could post more information about any other symptoms you have having that would be helpful.
Do you feel fatigued all the time. No matter how much you sleep?
Are you losing weight?
Do your low legs, ankles or foot appear to be swollen? Does your abdomen swell?
Have you ever coughed or vomited blood?
If you provide your location we can probably help you find a transplant center.
Hang in there you will get the help you need.
Hector
Wha-hey....Is this an MRI of your brain? Not sure but you might want to try the Neurology Community. Hope everything is OK :)
Sounds like this forum would be best for you....... Good luck
http://www.medhelp.org/forums/Cirrhosis-of-the-Liver/show/1390
http://www.medhelp.org/forums/Cirrhosis-of-the-Liver/show/1390
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