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Asterixis

MedGen UID:
115916
•Concept ID:
C0232766
•
Sign or Symptom
Synonyms: Flapping tremor; Liver flap
SNOMED CT: Asterixis (32838008); Flapping tremor (32838008); Liver flap (32838008)
 
HPO: HP:0012164

Definition

A clinical sign indicating a lapse of posture and is usually manifest by a bilateral flapping tremor at the wrist, metacarpophalangeal, and hip joints. [from HPO]

Professional guidelines

PubMed

Post-stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management.
Tater P, Pandey S
Neurol India 2021 Mar-Apr;69(2):272-283. doi: 10.4103/0028-3886.314574. PMID: 33904435
Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies.
Hamed SA
Expert Rev Clin Pharmacol 2019 Jan;12(1):61-90. Epub 2019 Jan 11 doi: 10.1080/17512433.2019.1555468. PMID: 30501441
Drug-induced myoclonus: frequency, mechanisms and management.
Jiménez-Jiménez FJ, Puertas I, de Toledo-Heras M
CNS Drugs 2004;18(2):93-104. doi: 10.2165/00023210-200418020-00003. PMID: 14728056

Recent clinical studies

Etiology

Neurologic complications of acute and chronic renal disease.
Baumgaertel MW, Kraemer M, Berlit P
Handb Clin Neurol 2014;119:383-93. doi: 10.1016/B978-0-7020-4086-3.00024-2. PMID: 24365307
The neurological manifestations of acute liver failure.
Shawcross DL, Wendon JA
Neurochem Int 2012 Jun;60(7):662-71. Epub 2011 Nov 2 doi: 10.1016/j.neuint.2011.10.006. PMID: 22067133
Ifosfamide associated myoclonus-encephalopathy syndrome.
Savica R, Rabinstein AA, Josephs KA
J Neurol 2011 Sep;258(9):1729-31. Epub 2011 Mar 12 doi: 10.1007/s00415-011-5990-4. PMID: 21399985
Movement disorders.
Cardoso F, Jankovic J
Neurol Clin 1993 Aug;11(3):625-38. PMID: 8377747
Neurologic manifestations of pulmonary disease.
Jozefowicz RF
Neurol Clin 1989 Aug;7(3):605-16. PMID: 2671637

Diagnosis

Minimal Hepatic Encephalopathy.
Redfield R, Latt N, Munoz SJ
Clin Liver Dis 2024 May;28(2):237-252. Epub 2024 Feb 8 doi: 10.1016/j.cld.2024.01.004. PMID: 38548436
Current approaches to hepatic encephalopathy.
Vidal-Cevallos P, Chávez-Tapia NC, Uribe M
Ann Hepatol 2022 Nov-Dec;27(6):100757. Epub 2022 Sep 14 doi: 10.1016/j.aohep.2022.100757. PMID: 36115576
Asterixis.
Ellul MA, Cross TJ, Larner AJ
Pract Neurol 2017 Jan;17(1):60-62. Epub 2016 Nov 2 doi: 10.1136/practneurol-2016-001393. PMID: 27807107
Movement disorders and stroke.
Defebvre L, Krystkowiak P
Rev Neurol (Paris) 2016 Aug-Sep;172(8-9):483-487. Epub 2016 Jul 28 doi: 10.1016/j.neurol.2016.07.006. PMID: 27476417
Asterixis.
Gokula RM, Khasnis A
J Postgrad Med 2003 Jul-Sep;49(3):272-5. PMID: 14597795

Therapy

Flapping Tremor: Unraveling Asterixis-A Narrative Review.
Rissardo JP, Muhammad S, Yatakarla V, Vora NM, Paras P, Caprara ALF
Medicina (Kaunas) 2024 Feb 21;60(3) doi: 10.3390/medicina60030362. PMID: 38541088Free PMC Article
Capecitabine-induced hyperammonemic encephalopathy.
Cerrella Cano C, Junquera Alonso E, Terroba Alonso M, Cano Calderero FX, Seoane Blanco L, Armesto González EM
Rev Esp Enferm Dig 2022 Jan;114(1):56. doi: 10.17235/reed.2021.8129/2021. PMID: 34154371
Movement disorders induced by psychiatric drugs that do not block dopamine receptors.
Friedman JH
Parkinsonism Relat Disord 2020 Oct;79:60-64. Epub 2020 Aug 26 doi: 10.1016/j.parkreldis.2020.08.031. PMID: 32871538
Drug-induced myoclonus: frequency, mechanisms and management.
Jiménez-Jiménez FJ, Puertas I, de Toledo-Heras M
CNS Drugs 2004;18(2):93-104. doi: 10.2165/00023210-200418020-00003. PMID: 14728056
Movement disorders.
Cardoso F, Jankovic J
Neurol Clin 1993 Aug;11(3):625-38. PMID: 8377747

Prognosis

Current approaches to hepatic encephalopathy.
Vidal-Cevallos P, Chávez-Tapia NC, Uribe M
Ann Hepatol 2022 Nov-Dec;27(6):100757. Epub 2022 Sep 14 doi: 10.1016/j.aohep.2022.100757. PMID: 36115576
Post-stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management.
Tater P, Pandey S
Neurol India 2021 Mar-Apr;69(2):272-283. doi: 10.4103/0028-3886.314574. PMID: 33904435
Movement disorders and stroke.
Defebvre L, Krystkowiak P
Rev Neurol (Paris) 2016 Aug-Sep;172(8-9):483-487. Epub 2016 Jul 28 doi: 10.1016/j.neurol.2016.07.006. PMID: 27476417
Asterixis.
Agarwal R, Baid R
J Postgrad Med 2016 Apr-Jun;62(2):115-7. doi: 10.4103/0022-3859.180572. PMID: 27089111Free PMC Article
Clinical management of hepatic encephalopathy.
Schiano TD
Pharmacotherapy 2010 May;30(5 Pt 2):10S-5S. doi: 10.1592/phco.30.pt2.10S. PMID: 20412035

Clinical prediction guides

Cortical activation associated with asterixis in manifest hepatic encephalopathy.
Butz M, Timmermann L, Gross J, Pollok B, Südmeyer M, Kircheis G, Häussinger D, Schnitzler A
Acta Neurol Scand 2014 Oct;130(4):260-7. Epub 2013 Dec 24 doi: 10.1111/ane.12217. PMID: 24372275
Clinical management of hepatic encephalopathy.
Schiano TD
Pharmacotherapy 2010 May;30(5 Pt 2):10S-5S. doi: 10.1592/phco.30.pt2.10S. PMID: 20412035
Symptomatic myoclonus.
Borg M
Neurophysiol Clin 2006 Sep-Dec;36(5-6):309-18. Epub 2007 Jan 17 doi: 10.1016/j.neucli.2006.12.006. PMID: 17336775
Negative myoclonus.
Tassinari CA, Rubboli G, Gardella E
Clin Neurosci 1995-1996;3(4):209-13. PMID: 8891393
L-dopa-induced asterixis.
Kobayashi I, Osawa M, Ohta K, Maruyama S
Folia Psychiatr Neurol Jpn 1985;39(4):507-13. doi: 10.1111/j.1440-1819.1985.tb00804.x. PMID: 3833629

Recent systematic reviews

Hyperammonemia associated with distal renal tubular acidosis or urinary tract infection: a systematic review.
Clericetti CM, Milani GP, Lava SAG, Bianchetti MG, Simonetti GD, Giannini O
Pediatr Nephrol 2018 Mar;33(3):485-491. Epub 2017 Nov 13 doi: 10.1007/s00467-017-3829-7. PMID: 29134448
Rifaximin vs. conventional oral therapy for hepatic encephalopathy: a meta-analysis.
Eltawil KM, Laryea M, Peltekian K, Molinari M
World J Gastroenterol 2012 Feb 28;18(8):767-77. doi: 10.3748/wjg.v18.i8.767. PMID: 22371636Free PMC Article
Wernicke encephalopathy after obesity surgery: a systematic review.
Singh S, Kumar A
Neurology 2007 Mar 13;68(11):807-11. doi: 10.1212/01.wnl.0000256812.29648.86. PMID: 17353468

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