Possible Causes for asterixis Chronic Kidney Insufficiency Neuromuscular abnormalities with asterixis and muscle twitching are common, as are muscle cramps. [meddean.luc.edu] Acute Renal Failure 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] 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] Tremor, apraxia, incoordination and impaired handwriting Tremor, apraxia, incoordination and impaired handwriting Triphasic waves (5 cycles/s) 2 Lethargy, slow responses Asterixis [dx.doi.org] 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 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] 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] Metabolic Encephalopathy Asterixis is a flapping movement produced by unsustained muscle contraction against gravity. [aneskey.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] Asterixis cannot be elicited in patients with hepatic encephalopathy in what stage? A. 1 B. 2 C. 3 D. 4 E. 5 D. [brainscape.com] Acute Liver Failure There was bilateral pitting edema, ascites and marked asterixis. [livertox.nih.gov] 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] 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] 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] Hepatopathy 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] 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] 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] 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] Uremic Encephalopathy 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] […] coma Physical Physical examination findings may include the following: Altered mental status (confusion) Cranial nerve signs (nystagmus) Papilledema Hyperreflexia, clonus, asterixis [emedicine.medscape.com] Ornithine Transcarbamylase Deficiency […] 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] 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] Symptoms are mainly neuropsychiatric (eg, confusion, asterixis, coma). Diagnosis is based on clinical findings. [msdmanuals.com] […] overview of one of the more common complications of cirrhosis, including its pathophysiology (and relationship to ammonia), risk factors, clinical presentation (including asterixis [youtube.com] Hepatitis C BMJ Case Rep. 2018 Jul 25;2018. pii: bcr-2018-225817. doi: 10.1136/bcr-2018-225817. Author information 1 Gastroenterology, Instituto Portugues de Oncologia do Porto Francisco Gentil, EPE, Porto, Porto, Portugal. 2 Internal Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Lisboa, Portugal. 3 Unidade de Investigação em[…] [ncbi.nlm.nih.gov] Reye Syndrome A case of Reye syndrome in an infant associated with culture-proven Hemophilus influenzae type d infection and probable meningitis is presented. This represents the second such reported case and the first to be described in detail. The criteria for the clinical and chemical diagnosis of Reye syndrome are reviewed.[…] [ncbi.nlm.nih.gov] Respiratory Acidosis Signs include gait disturbance, tremor, blunted deep tendon reflexes, myoclonic jerks, asterixis, and papilledema. [merckmanuals.com] Equipment Increased dead space, improper connection Obstructive pulmonary disease (chronic) COPD, asthma, pneumonia Clinical Vasodilation, sweaty, tachycardic, mydriasis, asterixis [lifeinthefastlane.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] 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] Macronodular Cirrhosis […] liver disease, hemochromatosis) EXTREMITIES: Pedal edema (hypoalbuminemia, failure of right side of the heart), arthropathy (hemochromatosis) NEUROLOGIC: Flapping tremor, asterixis [encyclopedia.lubopitko-bg.com] On physical examination, she has mild asterixis, generalized jaundice, and a distended abdomen with positive fluid wave. [medbullets.com] 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] 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] Bronchitis There are low levels of oxygen in the blood and high levels of carbon dioxide which can cause other signs such as bounding pulse, asterixis (flapping of the hands), and in [healthengine.com.au] Acute Alcohol Intoxication Evaluation for the development of right upper quadrant tenderness, icterus, jaundice, ascites, or encephalopathy with or without asterixis, indicating the progression to alcoholic [clinicaladvisor.com] Usually, people with liver failure also have liver flap (asterixis): When the arms and hands are outstretched, the hands suddenly drop, then resume their original position [msdmanuals.com] 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] Liver Cirrhosis We present a case of decompensated liver cirrhosis with ascites, which had history of asterixis, impaired balance with swaying gait along with mild irritability since 1 month [ncbi.nlm.nih.gov] Signs of hepatic encephalopathy: Asterixis ('flapping tremor'); suggests hepatic encephalopathy. [patient.info] Hold that position for several seconds and you will feel a slow, clonic flexion-relaxation movement against your hand if asterixis is present. [patient.info] Cryptogenic Cirrhosis […] etiologies and may have signs and symptoms that include jaundice, altered mental status, palmar erythema, spider angiomata, abdominal distention, weight loss, edema, varices, asterixis [statpearls.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] Portal Cirrhosis 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] Signs of the illness may include ascites; asterixis; bleeding from gums, nose, or gastroesophageal varices; “mousy” breath odor; edema; jaundice; and an irregular liver edge [medical-dictionary.thefreedictionary.com] […] possible consequences References:[10] Clinical features Nonspecific symptoms (patients are often initially asymptomatic) Fatigue, malaise, weight loss Jaundice Pruritus Asterixis [amboss.com] Cardiac Cirrhosis 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] […] 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] 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]
