2.  Mininal hepatic encephalopathy
 Episodic
 Persistent

3.  Selective attention
 Visuospatial abilities
 Fine motor skills
 Memory

4. For visuo constructive
abilities

5. Number connection test for mhe

6. Block design test -
visuospatial and motor skill

7. Line drawing
test – motor
speed and
accuracy

8. Pure motor speed

9. Cognitive assessment
by STOOP test

10.  AMMONIA – MOST IMPORTANT
 CNS NEUROTRANSMITTER EXPRESSION ,
RECEPTOR EXPRESSION and function –
 GABA- BZD system
 Neurosteroid ( allopregnenolone , tetra
hydrodeoxycorticosterone )
 Astrocyte swelling and increased glutamine
 Brain edema
 Altered brain glucose metabolism
 Serotonin ,NO ,manganese , opioid peptides

11. GRADE INTELLECTUAL NEUROMUSCULAR
0 NORMAL normal
MINIMAL Subtle changes in work or driving Psychometrric analysis
1 Personality , attention , deprresed .
Irritability
Tremor , incordination
2 Sleep cycle altered , mood &
behaviour change ,cognitive
dysfunction
Asterixis , ataxic gait ,
slow ,slurred speech
3 Somnolence , confusion ,
disorientation ,amnesia
Mnuscular rigidity ,
nystagmus , babinski ,
clonus , hyporeflexia
4 Stupor & coma Oculocephalic reflex ,
unrenponse to noxious
stimuli

12. MR SPECTROSCOPY – SHOWING DECRESED
GLUTAMATE PEAK AND INCREASED
MYOINOSITOL AND CHOLINE PEAK AFTER
LIVER TRANSPLATATION

13.  For quantitative measurement of brain changes
particularly in globus pallidus , posterior limb
of internal capsule , caudate nucleus
Critical flicker frequency test