nternal medicine department,. Ain Shams University.*** Neurology department; Banha University **** Clinical Pathology department, Zagazeg University. ABSTRACT Background and Aims: Peripheral and autonomic neuropathy has been reported in association with chronic liver disease. However, the precise incidence, severity and characteristics of neuropathy, and the relationship of neuropathy to different etiologies of liver disease have not been defined. This study was designed to evaluate the incidence and character of peripheral and autonomic neuropathy in patients with HBV and HCV related liver cirrhosis. The effect of severity of liver disease on the incidence and severity of neuropathy were also studied. Methods: 44 patients with liver cirrhosis related to viral infection (23 HBV and 2I HCV) were evaluated clinically and electro physiologically to detect any evidence of peripheral or autonomic neuropathy. Patients with evidence of vitamin B12 deficiency , diabetes mellitus, alcoholic or other identifiable cause of peripheral and autonomic neuropathy were excluded from the study. In this study, Nerve conduction studies(NCS) quantitative sensory tests and autonomic function tests were performed after full history and clinical evaluation . Results: Symptoms attributable to peripheral neuropathy consisting of mild cramps, parasthesia or numbness were present in seven (16%) patients. They were generally mild and not disabling .Clinical signs of peripheral neuropathy and autonomic were found in 10 (23%) and 21 (48%) of patients respectively. Nerve conduction studies were abnormal in 32 (73%) patients. Ninety percent of the patients who had autonomic neuropathy also had evidence of somatic neuropathy. The pattern of involvement was predominantly of an axonal sensory motor polyneuropathy. Neuropathy was found both in patients with HBV and HCV related cirrhosis with no statistical difference between them. The severity of liver disease have a significant bearing on the incidence and severity of either peripheral or autonomic neuropathy. Conclusions: The present study reveals that a significant number of patients presented by liver cirrhosis related to viral infection (HBV or HCV) show evidence of peripheral and autonomic neuropathy, which is sub clinical in a majority of these patients. The cause of neuropathy was probably the liver disease itself The incidence and severity of this neuropathy was related to the severity of liver cirrhosis. |
