Asterixis: Causes & Reasons

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Possible Causes for Asterixis

Hepatic Encephalopathy

Secondary end points were mortality from HE or any other cause, decrease in mental status grade, asterixis grade, serum Ammonia grade, NCT grade. [ncbi.nlm.nih.gov]

Clinical features include lethargy and confusion (frequently progressing to coma); asterixis; nystagmus, pathologic; brisk oculovestibular reflexes; decorticate and decerebrate [icd9data.com]

Asterixis can be detected. 26 27. Grade 2 Lethargy or apathy. Disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. [slideshare.net]

Metabolic Encephalopathy

Asterixis is caused by the loss in voluntary muscle postural tone of the head, tongue, limbs or trunk. [symptoma.com]

Asterixis results from the loss of postural tone in voluntary muscles of the limbs, trunk, head or tongue. [ncbi.nlm.nih.gov]

Asterixis is a flapping movement produced by unsustained muscle contraction against gravity. [aneskey.com]

Dialysis Dementia

[…] water. 7 Presenting symptoms consist of: 3, 24 dysarthria apraxia slurred speech with stuttering and hesitation Within months, other symptoms develop: 3, 16, 24 myoclonus asterixis [epilepsy.com]

These symptoms are followed by shortened attention span and muscular incoordination, asterixis, and lethargy, progressing to stupor and coma. [alzheimer-europe.org]

Findings include the following: Myoclonic jerks, twitches, or fasciculations (ie, uremic twitch-convulsive syndrome postulated by Adams et al in 1997) Asterixis Chorea [5] [emedicine.medscape.com]

Liver Failure

Drowsiness and confusion Parotid gland enlargement Spider angiomas Icterus Bilateral parotid swelling ( Credit ) Diminished axillary hair Spider angioma Gynecomastia in a male Asterixis [stanfordmedicine25.stanford.edu]

Clinical features include lethargy and confusion (frequently progressing to coma); asterixis; nystagmus, pathologic; brisk oculovestibular reflexes; decorticate and decerebrate [icd10data.com]

IVb : •no response Signs Trouble drawing figures, performing mental tasks Asterixis, fetor hepaticus, incontinence Asterixis, hyperreflexia, extensor reflexes, rigidity Areflexia [slideshare.net]

Hepatopathy

Abnormal findings suggestive of cirrhosis include: Jaundice Spider angiomata Palmar erythema Caput medusa Palpable left lobe of the liver Splenomegaly Ascites Clubbing Asterixis [hiv.va.gov]

Variable abnormalities of neurological and psychiatric function, including insomnia, hypersomnia, irritability, confusion, disorientation, hyperactive deep tendon reflexes, and asterixis [hiv.va.gov]

Ornithine Transcarbamylase Deficiency

Carbamazepine-associated asterixis and hyperammonemia. Am J Psychiatry. 1988; 145:269-70 EN. Adams, A Marks, and MH. [itjem.org]

[…] from OTC deficiency can be manifested clinically by some or all of the following: Anorexia Irritability Heavy or rapid breathing Lethargy Vomiting Disorientation Somnolence Asterixis [emedicine.com]

Hyperammonemia in asterixis induced by carbamazepine: two case reports. Acta Neurol Scand. 1984; 69:186-9 Rivelli M, El-Mallakh RS, Nelson WH. [itjem.org]

Hepatorenal Syndrome

In subsequent admissions, he had asterixis, nausea, vomiting, jaundice, and worsening pedal edema. [ncbi.nlm.nih.gov]

Asterixis or also known as liver flap, a tremor observed on the patient’s wrist when it is dorsiflexed (extended). [syndrome.org]

Clinical exam may reveal features of liver and renal disease which may include the following: Upper extremity may show palmar erythema, asterixis and clubbing. [symptoma.com]

Acute Liver Failure

There was bilateral pitting edema, ascites and marked asterixis. [livertox.nih.gov]

Liver palms are red and an hepatic flap, also called asterixis, may be present: Hyperextend the fingers and wrist, gently pushing back and a slow clonic movement is the liver [patient.info]

In older children, signs and symptoms are identical to those in adults but the classical symptoms of asterixis, tremors, and fetor hepaticus are often absent. [em-consulte.com]

Acute Kidney Injury

Such symptoms include Anorexia Nausea Vomiting Weakness Myoclonic jerks Seizures Confusion Coma Asterixis and hyperreflexia may be present on examination. [merckmanuals.com]

Mental status changes Nausea and vomiting Pruritus Seizures (if blood urea nitrogen level is very high) Shortness of breath (if volume overload is present) Physical findings Asterixis [aafp.org]

Other presentations of acute kidney injury may include development of uremic encephalopathy (manifested by a decline in mental status, asterixis, or other neurologic symptoms [aafp.org]

Portal Hypertension

They may also have a flapping tremor (asterixis), fetor hepaticus (a sweet musty aroma of the breath), hyperventilation and hypothermia. [patient.info]

[…] gastropathy: asymptomatic, chronic anemia, or acute upper GI bleeding – Ascites: abdominal distention, abdominal pain, early satiety, or dyspnea – Altered neurocognitive function: asterixis [clinicaladvisor.com]

[…] dysfunction Muscle cramps (common in patients with cirrhosis), muscle wasting Dupuytren contracture Palmar erythema and leukonychia: May be present in patients with cirrhosis Asterixis [emedicine.com]

Chronic Kidney Insufficiency

Neuromuscular abnormalities with asterixis and muscle twitching are common, as are muscle cramps. [meddean.luc.edu]

Acute Fatty Liver of Pregnancy

Symptoms may rapidly progress from restlessness, confusion, and disorientation to asterixis, seizures, psychosis, and ultimately coma. [6] Other systemic effects include respiratory [najms.org]

Wilson Disease

Testicular atrophy Small irregular shrunken liver Anaemia Caput medusae Decompensation[edit] Drowsiness (encephalopathy) Hyperventilation (encephalopathy) Metabolic flap/asterixis [en.wikipedia.org]

In the second stage, the patient is moderately obtunded but still responsive, and asterixis can be elicited. [intranet.tdmu.edu.ua]

Diagnosis The diagnosis of hepatic encephalopathy depends on documentation of mental obtundation, asterixis, and fetor hepaticus. [intranet.tdmu.edu.ua]

Encephalopathy

(1:45) What is asterixis? What is the diagnostic utility of a cirrhotic with asterixis? (6:10) How do lactulose & rifaximin work? What are their indications? [clinicalcorrelations.org]

Individuals with encephalopathy also develop nystagmus, asterixis, seizures, tremors and jactitation. [symptoma.com]

Symptoms are mainly neuropsychiatric (eg, confusion, asterixis, coma). Diagnosis is based on clinical findings. [msdmanuals.com]

Uremic Encephalopathy

Workup in a patient presenting with confusion, nystagmus, hyperreflexia, clonus, asterixis and coma should include a thorough history and neurological examination. [symptoma.com]

3 In more severe uremia, muscle fasciculations and myoclonus may appear. 3 The combination of asterixis and myoclonus may be severe and has been termed uremic twitching. [epilepsy.com]

The clinical manifestations of uremic encephalopathy include mild confusional states to deep coma, often with associated movement disorders, such as asterixis. [ncbi.nlm.nih.gov]

Hepatitis C

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV). In the majority of cases, hepatitis C follows a mildly symptomatic, chronic course. But because of the risk of progression to cirrhosis and hepatocellular carcinoma, which can both be life-threatening, the timely diagnosis of infection is[…] [symptoma.com]

Respiratory Acidosis

Signs include gait disturbance, tremor, blunted deep tendon reflexes, myoclonic jerks, asterixis, and papilledema. [merckmanuals.com]

Signs include tremor, myoclonic jerks, and asterixis. Diagnosis is clinical and with ABG and serum electrolyte measurements. [merckmanuals.com]

Signs include tremor, myoclonic jerks, and asterixis. Diagnosis is clinical and with arterial blood gas and serum electrolyte measurements. [merckmanuals.com]

Reye Syndrome

Pathogens Influenza virus types A and B and varicella-zoster virus are the pathogens most commonly associated with Reye syndrome. Other pathogens include parainfluenza virus, adenovirus, coxsackievirus, measles, cytomegalovirus, Epstein-Barr virus, HIV, retrovirus, hepatitis virus types A and B, mycoplasma, chlamydia,[…] [emedicine.com]

Macronodular Cirrhosis

On physical examination, she has mild asterixis, generalized jaundice, and a distended abdomen with positive fluid wave. [medbullets.com]

Encephalopathy (ie liver flap - asterixis). Confusion/coma. Hypoalbuminaemia (oedema, leuconychia). Sepsis (pneumonia, septicaemia). [brainscape.com]

[…] liver disease, hemochromatosis) EXTREMITIES: Pedal edema (hypoalbuminemia, failure of right side of the heart), arthropathy (hemochromatosis) NEUROLOGIC: Flapping tremor, asterixis [encyclopedia.lubopitko-bg.com]

Toxic Liver Disease

As the disorder progresses, people cannot hold their hands steady when they stretch out their arms, resulting in a crude flapping motion of the hands (asterixis). [merckmanuals.com]

Abnormal findings suggestive of cirrhosis include: Jaundice Spider angiomata Palmar erythema Caput medusa Palpable left lobe of the liver Splenomegaly Ascites Clubbing Asterixis [hiv.va.gov]

Hand tremor (asterixis). Jaundice (yellowing of skin and eyes). Weight loss. Nausea. Fatigue. Abdomen swelling (peritoneal ascites). [drugabuse.com]

Dialysis Disequilibrium Syndrome

Clinical features of DDS: (1) headache (2) nausea and/or vomiting (3) disorientation (4) visual disturbances, often with papilledema (5) asterixis (6) variable confusion [meducator3.net]

[…] sessions.3 The symptoms of the syndrome include:3 irritability restlessness headache nausea emesis hypertension blurred vision seizures muscular twitching fasciculations asterixis [epilepsy.com]

[…] dialysis or during renal replacement therapy, usually self limited but can occasionally progress Headache Disorientation Nausea and vomiting Restlessness Visual disturbances Asterixis [wikem.org]

Cardiac Cirrhosis

[…] prodromal, impending, stuporous, and comatose prodromal ecephalopathy phase disorientation, forgetfulness, tremors, and sleep disturbances impending encephalopathy phase asterixis [quizlet.com]

Signs of hepatic encephalopathy: Asterixis ('flapping tremor'); suggests hepatic encephalopathy. [patient.info]

Tremor of the outstretched hands (asterixis) is common. These symptoms become more severe and may eventually progress to delirium, suicidal tendencies, and coma. [medical-dictionary.thefreedictionary.com]

Postrenal Azotemia

Signs and symptoms Oliguria or anuria (decreased or absent urine output) Fatigue Asterixis (flapping tremor) Decreased alertness Confusion Pale skin Tachycardia (rapid pulse [ipfs.io]

Asterixis Decreased alertness Confusion Pale skin Tachycardia (rapid pulse) Xerostomia (dry mouth) Thirst Edema(edema, anasarca) (swelling) Orthostatic blood pressure (rises [slideshare.net]

Prerenal Azotemia

Symptoms Signs and symptoms of prerenal azotemia include oliguria or anuria (reduced urinary flow or absence of urine), asterixis (a tremor of the wrist when the wrist is [renaldiet.us]

Signs and symptoms [ edit ] Oliguria or anuria (decreased or absent urine output) Fatigue Asterixis (flapping tremor) Decreased alertness Confusion Pale skin Tachycardia [en.wikipedia.org]

Toxic Encephalopathy

One patient developed asterixis after drug rechallenge. [ncbi.nlm.nih.gov]

[…] delirium, late finding in dementia) Symptoms of encephalopathy include: Hallucinations, delusions, agitation or lethargy; Irritation to light touch; Withdraw limbs unequally; Asterixis [quizlet.com]

• Motor findings that are strongly suggestive of a metabolic or toxic encephalopathy include postural-action tremor, asterixis, and multifocal myoclonus. • In comatose patients [medlink.com]

Hypoglycemic Encephalopathy

O Asterixis – flapping tremor – stage II (includes personality change and inappropriate behavior). O Posturing can be seen in stage IV. [slideshare.net]

3] Hypervigilance may be present; with or without: cognitive deficits, headache, epileptic seizures, myoclonus (involuntary twitching of a muscle or group of muscles) or asterixis [en.wikipedia.org]

No asterixis or myoclonus was present. [dartmouth.edu]

Chronic Respiratory Acidosis

Signs include gait disturbance, tremor, blunted deep tendon reflexes, myoclonic jerks, asterixis, and papilledema. [msdmanuals.com]

The mental status of the patient might be depressed due to higher levels of Pa CO 2 and may have signs of myoclonus, asterixis and seizures. [hxbenefit.com]

CO 2 retention in COPD patients causing worsening drowsiness Hypoventilation of any other cause Signs of CO 2 retention Confusion – as a result of peripheral vasodilation Asterixis [almostadoctor.co.uk]

Sepsis-Associated Encephalopathy

[…] being “not quite right” even thought abnormalities are not obvious to the bedside clinician may progress to coma other features such as anorexia, malaise, myoclonus and asterixis [lifeinthefastlane.com]

 Most common motor sign is paratonic rigidity or gegenhalten, a resistance to passive movement of limbs that is velocity-dependent  Asterixis, multifocal myoclonus, seizures [slideshare.net]

Asterixis can be detected. Stage 2. Lethargy or apathy. Minimal disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. [clevelandclinicmeded.com]

Acute Respiratory Acidosis

Signs include gait disturbance, tremor, blunted deep tendon reflexes, myoclonic jerks, asterixis, and papilledema. [msdmanuals.com]

[…] encephalopathy, a clinical syndrome that initially can present as irritability, headache, mental cloudiness, apathy, confusion, anxiety, and restlessness and can progress to asterixis [ime.acponline.org]

Signs include tremor, myoclonic jerks, and asterixis. Diagnosis is clinical and with ABG and serum electrolyte measurements. [msdmanuals.com]

Hemiballismus

[…] case-control design; control cohorts included a group of similar lesions randomized to different brain locations and a second group of lesions causing a separate movement disorder, asterixis [ncbi.nlm.nih.gov]

[…] after stroke comprise dystonia (2-4), chorea with or without hemiballismus (5), tremor (6), parkinsonism (7), segmental or focal myoclonus, athetosis, pseudathetosis, and asterixis [rjn.com.ro]