From the Guidelines
Hypoechogenic Liver Lesions with Neurological Symptoms A hypoechogenic liver lesion can manifest with neurological symptoms due to the accumulation of toxic substances, such as ammonia, that can cross the blood-brain barrier 1.
Clinical Presentation
Patients can present with alterations in mental state, such as confusion, somnolence, and in severe cases, hepatic encephalopathy, which requires prompt treatment with lactulose (2-3 grams per day) and rifaximin (550 mg twice a day for 7-10 days) 2.
- The therapy may also include the administration of folic acid and B vitamins to prevent nutritional deficiencies.
- Neurological symptoms can be observed in 21%-33% of patients with cirrhosis and sepsis, and in 60%-68% of those with septic shock 3.
Risk Factors
Hyponatremia is an independent risk factor for the development of hepatic encephalopathy in patients with cirrhosis, and the incidence of hepatic encephalopathy increases with decreasing serum sodium concentrations 3, 4.
- Diabetes mellitus has been suggested as a risk factor for the development of hepatic encephalopathy, especially in patients with hepatitis C virus (HCV) cirrhosis.
Treatment
Liver transplantation remains the only treatment option for hepatic encephalopathy that does not improve with other treatments, but it is not without risks 5.
- The management of potential transplant candidates should include the identification and embolization of large portosystemic shunts before or during transplantation.
- Thiamine deficiency should be considered in patients with alcoholic liver disease or malnutrition in end-stage cirrhosis, and thiamine should be given intravenously before glucose-containing solutions in cases of doubt 3, 4.
From the Research
Implications of a Hypoechogenic Liver Lesion with Neurological Symptoms
- The presence of a hypoechogenic liver lesion with neurological symptoms can have various implications, depending on the underlying cause of the lesion and the symptoms presented 6, 7.
- Neurological symptoms such as cognitive complaints, memory and concentration problems, headache, anosmia, ageusia, vertigo, and insomnia can occur in patients with a history of COVID-19, and may be related to post-COVID-19 syndrome 7.
- In some cases, neurological symptoms can be associated with infections such as Bartonella henselae, which can cause cat-scratch disease (CSD) and lead to neurological presentations such as isolated aseptic meningitis, neuroretinitis, and isolated optic neuritis 6.
- The characterization of focal hepatic lesions, including hypoechogenic lesions, can be done using different sonographic techniques, such as conventional sonography, real-time compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography 8.
- The choice of sonographic technique can affect the diagnostic value of the imaging study, with tissue harmonic compound sonography showing superior results for lesion conspicuity and overall image quality in solid lesions 8.
- There is limited evidence directly linking hypoechogenic liver lesions to neurological symptoms, and further research is needed to fully understand the implications of such a finding 9, 10.