Liver Disease and Neurology

PURPOSE OF REVIEW: Neurologists often encounter patients with acute and chronic liver disease and must be aware of how these diseases can affect the nervous system. This is particularly true when evaluating patients with alterations in cognition and level of consciousness. Wilson disease, while uncommon, is a treatable condition with many neurologic and psychiatric symptoms. Neurologic disorders associated with liver disease may affect not only the brain, but also the spinal cord and peripheral nervous system. This article reviews the association of liver disease and the nervous system and provides new information regarding diagnostic and therapeutic approaches to evaluating patients with liver diseases. RECENT FINDINGS: Early recognition of hepatic encephalopathy may be possible using a combination of clinical suspicion and various neuropsychological studies. Management of severe hepatic encephalopathy from acute liver failure is important to neurologists involved in neurocritical care. Next-generation genetic testing may aid in the diagnosis of patients suspected of having Wilson disease. The relationship of numerous neurologic findings from hepatocerebral degeneration and from viral hepatitis is more widely recognized. SUMMARY: It is important for neurologists to recognize the neurologic symptoms that may occur in patients with acute and chronic liver failure, Wilson disease, and viral hepatitis to inform prompt diagnostic and management decisions.