Which neurological sign is characteristically associated with hepatic encephalopathy?

Which neurological sign is characteristically associated with hepatic encephalopathy?

• A. Chorea
• B. Asterixis (flapping tremor)
• C. Nystagmus
• D. Tremor at rest

Answer: (B)

Hepatic encephalopathy presents with metabolic brain dysfunction due to liver failure or portosystemic shunting, leading to neuropsychiatric and motor signs. The feature most characteristic of this condition is asterixis, the irregular flapping tremor of the hands that appears when the wrists are extended. This sign reflects a brief lapse in the ability to maintain continuous muscle tone because the brain is not processing motor control normally from toxin buildup (notably ammonia). Clinically, you may also see changes in mental status and other motor abnormalities, but the flapping tremor is the hallmark. Chorea, nystagmus, and a tremor at rest are associated with other disorders (basal ganglia dysfunction, cerebellar/vestibular issues, and Parkinsonian syndromes, respectively) and are not the characteristic sign of hepatic encephalopathy.

Hepatic encephalopathy presents with metabolic brain dysfunction due to liver failure or portosystemic shunting, leading to neuropsychiatric and motor signs. The feature most characteristic of this condition is asterixis, the irregular flapping tremor of the hands that appears when the wrists are extended. This sign reflects a brief lapse in the ability to maintain continuous muscle tone because the brain is not processing motor control normally from toxin buildup (notably ammonia). Clinically, you may also see changes in mental status and other motor abnormalities, but the flapping tremor is the hallmark.

Chorea, nystagmus, and a tremor at rest are associated with other disorders (basal ganglia dysfunction, cerebellar/vestibular issues, and Parkinsonian syndromes, respectively) and are not the characteristic sign of hepatic encephalopathy.