| Abstract: |
Our study included 100 patients presented with different types of chronic liver diseases with age range (2:17) years with a median (IQR) of 10 (7) years. They were 61 males and 39 females. Patients were recruited from pediatric unit at National hepatology and tropical medicine research Institute (NHTMRI).We attempted to find out the presence of any neurological associations related to presence of chronic liver diseases through a signs and a symptoms approach including complete history taking, complete examination and investigations ;liver function tests, serum ammonia, EEG, MRI, Abdominal ultrasound imaging and liver biopsy.Diagnoses of liver diseases in the study group was; chronic hepatitis C virus (HCV) and/or chronic Hepatitis B virus (HBV) in 39%, autoimmune hepatitis (AIH) in 29%, Wilson’s disease in 13%, glycogen storage disease (GSD) in 10% and 9% had other diagnoses. Patients with chronic viral hepatitis were 30 cases with chronic HCV, 5 cases with chronic HBV and 4 cases with combined HBV and HCV infection. Other diagnoses included 2 cases with giant cell hepatitis and one case with each of the following; non-alcoholic fatty liver disease (NAFLD), progressive familial intrahepatic cholestasis (PFIC), Gilbert syndrome, sclerosing cholangitis, Bardet Biedl syndrome, Budd Chiari syndrome and congenital hepatic fibrosis.As regards the central nervous system symptoms of the study group; 58% of cases had headache, 52% had cramps, 19% had numbness, Easily distraction was present in 18% of cases, 13% gave history of seizures and 12% had tremors. Cases with tremors were 9 with static, 2 with intension and 1 with flapping tremors. Bulbar symptoms were positive in 10% of cases (dysphagia), generalized weakness in 9%, recurrent fainting attacks in 8, visual abnormalities in 3% of cases and hearing abnormalities in 3% of cases. Shaking legs was positive in 2% of cases, excessive sweating in 2% of cases, hyperflexibilty in 1% of cases and generalized lipodystrophy in 1% of cases.Children with abnormal behavior patterns were 22% with anxiety, 6% with depression and 4% with violence attitude.Delirium (altered state of consciousness) was present in 24% of cases. As regard to speech abnormalities; 23% of cases had slurred speech, 14% had dysarthria, 1% had staccato speech and 1% was aphasic.Altered cognition was present in 19% of cases. Hepatic encephalopathy could be detected in 21% of cases and they were grade one.
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