From the Guidelines
Asterixis is not an emergency in itself, but its presence can indicate an underlying serious condition that requires urgent medical attention, particularly if associated with symptoms like confusion, drowsiness, or difficulty breathing. According to the French recommendations for the diagnosis and management of hepatic encephalopathy 1, asterixis is one of the signs strongly suggestive of hepatic encephalopathy (HE), which is a group of neurological or neuropsychiatric symptoms caused by liver disease and/or a portosystemic shunt. The presence of asterixis, along with other signs such as psychomotor slowing, sleep–wake inversion, temporospatial disorientation, and impaired consciousness, should prompt a systematic investigation for overt HE 1.
The underlying cause of asterixis, such as hepatic encephalopathy, can have significant implications for morbidity, mortality, and quality of life. For instance, the occurrence of a first episode of overt HE is independently associated with increased mortality, with 1- and 3-year cumulative survival rates of 42% and 23%, respectively 1. Therefore, it is crucial to investigate and manage the underlying condition promptly.
Key points to consider in the management of asterixis include:
- Investigating liver function, kidney function, electrolytes, and blood gases to identify the underlying cause
- Screening for hepatic encephalopathy in all patients with cirrhosis, regardless of their liver function status 1
- Using therapeutic strategies for HE, such as lactulose or rifaximin, to reduce ammonia levels and improve symptoms
- Monitoring for signs of overt HE, such as asterixis, psychomotor slowing, and impaired consciousness, and investigating these signs systematically 1
In summary, while asterixis itself is not typically an emergency, its presence can indicate a serious underlying condition that requires prompt medical attention to prevent poor outcomes and improve quality of life.
From the Research
Definition and Causes of Asterixis
- Asterixis is a motor control disorder characterized by abnormal movements of the limbs during posture maintenance 2.
- It is usually bilateral and associated with toxic-metabolic encephalopathies, but can also be unilateral and indicate focal brain damage 2, 3.
- Asterixis can result from various causes, including medications, renal disorder, hepatic dysfunction, pulmonary insufficiency, stroke, and other brain lesions 3.
Clinical Significance of Asterixis
- Asterixis is an important clinical sign that can indicate the presence of underlying neurological or medical conditions 4.
- It can be a presentation of cerebellar ischemic stroke, and its presence can aid in the diagnosis of this condition 5.
- Asterixis can be easily overlooked during routine neurological examinations, especially when it is unilateral 2.
Emergency Implications of Asterixis
- Asterixis can be a sign of an underlying emergency condition, such as cerebellar ischemic stroke 5.
- In some cases, asterixis can be a presenting symptom of a life-threatening condition, and its prompt recognition and evaluation can be crucial in initiating appropriate treatment 5.
- However, not all cases of asterixis are emergencies, and the clinical context and underlying cause of the asterixis must be taken into account when determining the urgency of the situation 3, 4.