[Hepatic encephalopathy syndrome].

The syndrome of hepatic encephalopathy includes all the neuropsychiatric changes which appear in acute and chronic liver diseases. To understand the pathophysiology of hepatic encephalopathy, it would be essential to accurately study cerebral activity in human, but it is impossible at present. Animal models of acute hepatic encephalopathy available at present, reproduce just a narrow aspect of the human disease. Moreover, there is no useful animal model for chronic hepatic encephalopathy. Therefore, the exact pathophysiology of hepatic encephalopathy in human, is yet unknown. Theoretically, the disturbance of cerebral activity can be explained by the altered permeability of the blood-brain-barrier, the accumulation of neurotoxins, disturbance of neurotransmission by the altered substrate-supply, or by the disturbance of energy-balance. This review summarize those possible pathomechanisms, which are playing--in our present knowledge--important role in the development of hepatic encephalopathy.