Thread by @ebtapper, What is asterixis?Described~60 yrs ago by Adams/Foley Methods:60pts w/impending hepatic coma vs [...]

What is asterixis?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👋" title="Waving hand" aria-label="Emoji: Waving hand">Described~60 yrs ago by Adams/Foley

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👋" title="Waving hand" aria-label="Emoji: Waving hand">Methods:60pts w/impending hepatic coma vs controls

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👋" title="Waving hand" aria-label="Emoji: Waving hand">Flapping flexion/extension, best @ the

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤚" title="Erhobener Handrücken" aria-label="Emoji: Erhobener Handrücken">but happens even 2 the

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👁️" title="Auge" aria-label="Emoji: Auge">lids! Has intervening tremor (mini-asterixis)

Look 4 it while checking handgrip!
#livertwitter
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What is asterixis?https://abs.twimg.com/emoji/v2/... draggable=

Why asterixis?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">Adams/Foley:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤷" title="Person shrugging" aria-label="Emoji: Person shrugging">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Ammonia? Unlikely!(fig1)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="4⃣" title="Tastenkappe Ziffer 4" aria-label="Emoji: Tastenkappe Ziffer 4">They looked @

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧠" title="Gehirn" aria-label="Emoji: Gehirn">; swollen astrocytes! Particularly in the basal ganglia!(Fig3)
#livertwitter 2/4

Why asterixis?https://abs.twimg.com/emoji/v2/... draggable=

Why asterixis part 2

A study using magnetoencephalography showed:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">There is & #39;excessive corticomuscular motor coherence& #39;

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Diseased basal ganglia fail to select and pace the motor areas

This seems to confirm what Adams/Foley found in the brain

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Why asterixis part 2A study using magnetoencephalography showed:https://abs.twimg.com/emoji/v2/... draggable=

There is & #39;excessive corticomuscular motor coherence& #39; https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Diseased basal ganglia fail to select and pace the motor areasThis seems to confirm what Adams/Foley found in the brain3/4" title="Why asterixis part 2A study using magnetoencephalography showed:https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">There is & #39;excessive corticomuscular motor coherence& #39; https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Diseased basal ganglia fail to select and pace the motor areasThis seems to confirm what Adams/Foley found in the brain3/4" class="img-responsive" style="max-width:100%;"/>

But!

Asterixis can happen in non-cirrhotic patients!

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">Right after Adams/Foley paper, Conn found it in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🫁" title="Lungs" aria-label="Emoji: Lungs">disease! (fig1)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">Causes include any metabolic disturbance and meds(Figs 3-4)
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But!Asterixis can happen in non-cirrhotic patients!https://abs.twimg.com/emoji/v2/... draggable=

Right after Adams/Foley paper, Conn found it in https://abs.twimg.com/emoji/v2/... draggable="false" alt="🫁" title="Lungs" aria-label="Emoji: Lungs">disease! (fig1)https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">Causes include any metabolic disturbance and meds(Figs 3-4)4/4" title="But!Asterixis can happen in non-cirrhotic patients!https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">Right after Adams/Foley paper, Conn found it in https://abs.twimg.com/emoji/v2/... draggable="false" alt="🫁" title="Lungs" aria-label="Emoji: Lungs">disease! (fig1)https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Can be seen in ~9% of neurology inpatients, 1% of neurology outpatients.(Fig2)https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">Causes include any metabolic disturbance and meds(Figs 3-4)4/4">

To review:

Asterixis has many causes

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1️⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">metabolic disarray

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2️⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">astrocyte swelling (likely from glutamine excess due to increased ammonia metabolism)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="3️⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">meds meds meds

#livertwitter #cirrhosis

If you would like more references for the physiology of HE: https://mayoclinicproceedings.org/retrieve/pii/S0025619615002177">https://mayoclinicproceedings.org/retrieve/...

Refining the Ammonia Hypothesis

Hepatic encephalopathy (HE) is one of the most important complications of cirrhosis and portal hypertension. Although the etiology is incompletely understood, it has been linked to ammonia directly...

https://mayoclinicproceedings.org/retrieve/pii/S0025619615002177

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