diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy children and adolescents with cirrhosis

Subclinical or minimal hepatic encephalopathy [SHE or mHE], in con-to hepatic encephalopathy is not associated with overt neuropsychiatric symptoms but rather with subtle changes detected by special psychomotor and/or neurophysiologic tests. The purpose of this study was to elucidate the validity of the neuropsychological and neurophysiological to diagnose SHE in children and adolescents with liver cirhosis. Furthermore, to detect its prevalence in a specific period. A prospective controlled study was applied on 23 patients [10 males and 13 females with mean age 10.24 +/- 3.87 years] with different etiologies of liver cirrhosis through the period from August 2002 to August 2003. Fifteen healthy and adolescents with matched age, sex and education standard, included as a control group. All patients and controls were subjected to thorough clinical evaluation, laboratory tests of liver functions, neuropsychological assessment using the Egyptian version of Wechsler intelligence tests, visual and mapping analysis of electroencephalographic records and event related potential [P300] testing. Patients and controls were age and sex matched d showed no significant difference in periods of education. Serum bilirubin and prothrombin time were significantly affected in patients compared with controls. Verbal, performance and full scale IQ were all significantly affected in patients compared with controls; a cut off point of abnormal test performance was seated at scaled score 2 SD below th mean of the controls. Patients have sigr4flcant slowing in EEG back ground activity compared to controls [P=0.001]; a cut off point for diagnosis of slow activity was seated at 6.8 C/S. Prevalence of SHE among cirrhotic patients was 47.8% by applying two abnormal neuropsychologic tests and 65.2% by applying two abnormal psychologic tests together with significant slowing of EEG background activity. Prevalence of SHE among patients with Child-Pugh class B/C cirrhosis was significantly higher than that recorded in patients with class A cirrhosis [P<0.05] Event related potentials [P300] mean wave latency and mean wave amplitude showed no significant differences between patients and controls however, cirrhotic patients with SHE had significant prolongation of mean P300 wave latency than patients without SHE [P=0. 031]. Clinical follow up [5 +/- 1 .64months] revealed that two out of fifteen mHE diagnosed patients died after 3 and 5 months from initial testing and the two were Child-Pugh class C and overt encephalopathy was precipitated by sepsis. Minimal hepatic encephalopathy is quite prevalent in our patients [65.2%] and the diagnosis can be ascertained by special neuropsychological and/or neurophysiological tests. Minimal hepatic encephalopathy is thought to predict the development of overt hepatic encephalopathy, thus it is clinically relevant

ENG profile in auditory neuropathy

Twelve patients with auditory neuropathy aged 11 - 34 years were subjected to ENG test battery including gaze, random saccades, pursuit, optokinetic, positional and bithermal water caloric tests. Twenty age and gender matched normal subjects were included as a control group. None of the 12 patients had history of vertigo or unsteadiness. Neither gaze evoked nor positional nystagmus was recorded in any patient. 7 patients out of 12 had abnormal gain of pursuit tracking and optokinetic nystagmus [< 0.7] and 2 out of the 7 had abnormal fixation index [> 50%]. Moreover, the average slow phase velocity of the total caloric response in auditory neuropathy patients showed statistically significant reduced values as compared to those obtained from the control group, however none of the 12 patients had total caloric response < 22 degrees/second. These results are suggestive of a potential peripheral vestibular dysfunction in addition to central vestibular dysfunction mainly at the level of brainstem

Autoinflation as a treatment for Eustachian tube dysfunction

Eustachian tube dysfunction ETD is one of the most common diseases affecting children. It requires trials of medical treatment and frequent follow up. On the other hand, failure of the non-invasive trials may indicate surgical intervention. This study showed complete clinical and audiological improvement in 63% of cases that underwent autoinflation as compared to 16% of cases in the control group. The autoinflation procedure still needs further study to explain the failure to achieve more successful results