Neurologic status of patients with liver disease. Correlation with cerebrospinal fluid and blood ammonia content

A highly suggestive correlation between blood ammonia levels on the one hand and alterations of mental status and characteristic involuntary movements on the other in patients with liver disease has been reported by many workers. 1-5 Complete reviews of our current knowledge of ammonia metabolism have been published recently by Bessman 6 and by Chalmers. 7 The concept of a relationship of blood and cerebrospinal fluid (CSF) ammonia levels to neurologic findings apart from mental changes and the typical hepatic "flap," however, has received relatively little attention. In particular, the correlation of specific findings in either the neurologic, general physical, or laboratory examinations of patients with liver disease, with blood or CSF ammonia levels has not, to our knowledge, been the subject of any rigorous study. The principal purpose of this report is to determine whether the ammonia levels of blood and cerebrospinal fluid of patients with liver disease have