Autonomic and peripheral (sensorimotor) neuropathy in chronic liver disease: A clinical and electrophysiologic study

Peripheral neuropathy has been reported in association with chronic liver d isease. However, the precise incidence, severity and characteristics of neu ropathy, and the relationship of neuropathy to different etiologies of Live r disease have not been defined. In this study, 58 patients with advanced l iver disease were evaluated in detail for the presence of neuropathy. Perip heral (sensorimotor) neuropathy was found in 71% and autonomic neuropathy w as found in 48% of the patients. Although the majority of patients were asy mptomatic, neurological examination showed distal sensory loss to pain, or vibration or distal loss of reflexes in 17 patients (29%). Sensory neuropat hy was seen more commonly than motor axonal polyneuropathy on nerve conduct ion studies. Quantitative sensory testing was frequently abnormal (62%) and cooling thresholds were more affected than vibration thresholds. Overall, the pattern of neuropathy in patients with liver disease conformed to the p attern expected in "dying back" or length-dependent neuropathy. The neuropa thy was most severe in patients with advanced hepatic decompensation. Compa rison of causes of liver disease showed no significant differences in the s everity of neuropathy among the different etiologies. In conclusion, axonal sensory-motor polyneuropathy and autonomic neuropathy are commonly seen in patients with end-stage liver disease of different causes.