The pathophysiogical basis of brain swelling of grey vs. white matter in acute liver failure are different: lessons from a study using MARS
Zwingmann C, Ytrebo L, Butterworth R, Revhaug A, Jalan R, Leibfritz D, Sen S, Rose C, Davies N
Hospital Saint-Luc, University of Bremen
Encephalopathy in acute liver failure (ALF) is characterised by increased brain water in grey and white matter (GM and WM). Our aim was to perform ex vivo 1H-NMR to explore previous observations that albumin dialysis (MARS) reduces cerebral swelling only in the WM. In ALF, brain water increases in GM and WM. However only 6/11 metabolite changes are similar. The MARS-induced normalisation of brain water in the WM was paralleled by a normalization of 7/11 metabolites. Since MARS only normalised WM tissue water, this suggests that increases in brain water in WM vs GM are associated with different pathophysiological mechanisms.