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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 controlsFlapping flexion/extension, best @ thebut happens even 2 the lids! Has intervening tremor (mini-asterixis)Look 4 it while checking handgrip!
#livertwitter
1/4
Why asterixis?
Adams/Foley:
Ammonia? Unlikely!(fig1)
Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)
They looked @
; swollen astrocytes! Particularly in the basal ganglia!(Fig3)
#livertwitter 2/4
Adams/Foley:Ammonia? Unlikely!(fig1)Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)They looked @; swollen astrocytes! Particularly in the basal ganglia!(Fig3) #livertwitter 2/4
Why asterixis part 2
A study using magnetoencephalography showed:
There is 'excessive corticomuscular motor coherence' Diseased 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:
There is 'excessive corticomuscular motor coherence' Diseased basal ganglia fail to select and pace the motor areasThis seems to confirm what Adams/Foley found in the brain
3/4
But!
Asterixis can happen in non-cirrhotic patients!
Right after Adams/Foley paper, Conn found it in 
disease! (fig1)
Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)
Causes include any metabolic disturbance and meds(Figs 3-4)
4/4
Asterixis can happen in non-cirrhotic patients!
Right after Adams/Foley paper, Conn found it in disease! (fig1)Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)Causes include any metabolic disturbance and meds(Figs 3-4)4/4
To review:
Asterixis has many causes
metabolic disarray
astrocyte swelling (likely from glutamine excess due to increased ammonia metabolism)
meds meds meds
#livertwitter #cirrhosis
If you would like more references for the physiology of HE: https://mayoclinicproceedings.org/retrieve/pii/S0025619615002177
Asterixis has many causes
metabolic disarray astrocyte swelling (likely from glutamine excess due to increased ammonia metabolism)meds meds meds#livertwitter #cirrhosis
If you would like more references for the physiology of HE: https://mayoclinicproceedings.org/retrieve/pii/S0025619615002177
