Dorothy FarrarAsterixis
Asterixis is a specific symptom associated with metabolic damage to the brain. As a result of damage to the liver and kidneys, impairment of the brain is possible. For this reason, patients affected by Asterixis suffer from a tremor of the hands. Asterixis is also sometimes referred to as flutter tremor.
What is an asterixis?
As part of the asterixis, there is a so-called coarse tremor of the hands . This is primarily caused by toxic or metabolic damage to the brain . An asterixis is therefore not a tremor in the traditional sense. Instead, it is a temporary loss of tone in the muscles , also known as negative myoclonus. This is followed by a corrective movement of the muscle.
The condition was first described by Foley and Adams in 1949. The extensors of the forearm muscles are temporarily locked, causing the hands to flex. The hand falls down, but is immediately corrected back into its original position by means of a quick stretching movement. If asterixis occurs in the legs, the ability to walk and stand is impaired, which in the majority of cases results in falls.
Flutter tremor quickly becomes apparent when the affected patient is asked to stretch out their arms, fingers, and hands long and straight. The coarse tremor is indicated by flexions in the wrist that are either rhythmic or arrhythmic. As a result, a reflex corrective movement occurs. If the affected person holds their arms by their sides, it appears as if they are flapping their wings. An asterixis and the associated movements show up on both sides in many cases. Sometimes, however, they appear asymmetrically.
Causes
Asterixis is a so-called symptomatic movement disorder, the cause of which in the majority of cases is damage to the brain. Sometimes the cause of the disease is sought in a negative myoclonus. A reflex corrective movement then appears. In most cases, flutter tremor is caused by metabolic encephalopathies. This means metabolic or metabolic brain damage. For this reason, asterixis, for example, also accompanies hepatic encephalopathies in some cases.
In addition, asterixis is a typical symptom in connection with acute liver failure or Wilson’s disease. Far more rarely, the underlying cause of the disease is the consumption of certain medications or kidney failure. Metabolic damage to the brain is possible if special substances form as part of metabolic diseases. These remain in the body and sometimes have a toxic effect. In most cases, asterixis is merely a symptom of another underlying disease.
Along with the tremors, other symptoms are possible, depending on the primary cause. In the context of renal insufficiency, in addition to asterixis, symptoms such as proteinuria, back pain or a change in color of the urine are also possible. With all organ damage, the brain damage can in principle also be associated with other accompanying symptoms. These are usually possible based on the localization of the damage to the brain. For example, motor skills, perception and other body processes are affected.
Diseases
- encephalopathy
When to the doctor?
Asterixis, often also called flutter tremor, is not an independent disease but the result of brain damage that has already occurred. If the symptom occurs suddenly and the person affected does not know the cause, then it is very important that he seeks specialist treatment as quickly as possible so that the underlying disease can be identified and, if possible, treated successfully.
In the worst case, if left untreated, it can lead to kidney or liver failure and this can be fatal. The tremor itself can hardly be reversed even with medical treatment, the damaged brain tissue can no longer regenerate.
However, the doctor treating you can also initiate physiotherapeutic and ergotherapeutic measures. They can help affected patients to deal better with the disease and its consequences in everyday life. It is even possible that parts of the brain that are still intact gradually take over the function of the damaged areas and that the symptoms can improve somewhat as a result.
Diagnosis and course
There are numerous different methods to choose from for diagnosing asterixis, and the doctor treating you decides which methods to use. If typical symptoms of asterixis appear, a suitable specialist should be consulted immediately. This is usually a neurologist. In many cases, this can already be recognized by visual diagnosis that an asterixis is present. In order to better assess the symptom, the patient needs to stretch out his hands and stand in the room.
If there is a coarse tremor, in most cases there is damage to the brain. Imaging methods are able to confirm and examine the damage in more detail. In order to determine the underlying causes for the occurrence of asterixis, a thorough medical history is essential. The doctor discusses the patient’s personal medical history and facts about their individual lifestyle with them.
For example, if the patient brings up a kidney or liver disease, the doctor will draw appropriate conclusions as to the cause of the symptom. In this way, asterixis can be diagnosed with relative certainty. If no metabolic diseases have been identified by the time of the examination, the affected patient has to undergo a large number of general examinations of the metabolic organs. The prognosis for asterixis is highly dependent on the primary cause.
Complications
The complications of asterixis are very diverse. Basically, the disease is accompanied by malaise , reduced well-being and a depressed mood. Increased irritability and difficult handling of the affected person are to be expected in everyday life. Since the motor skills are limited, there are difficulties in performing everyday tasks. This can cause a loss of professional activity.
In addition, with asterixis, there is pain in the hands and arms. These are variable in their intensity and can therefore be classified from bearable to very painful. At the same time, there may be a feeling of numbness in the affected regions. The permanent tension in the fingers, hands or arms leads to a strong strain on the muscles there. This can cause inflammation or further pain, such as sore musclestrigger. Asterixis itself often causes fewer complications than the underlying condition on which asterixis is based. In addition to pain and impairment, the underlying disease can also lead to organ failure. In particular, kidney failure is possible. This leads to problems with urine production. Acute kidney failure can be fatal. If chronic kidney failure occurs, high blood pressure , inflammation or infection are other possible complications.
Treatment and therapy
As part of the treatment of asterixis, the underlying disease must always be considered. Because this is responsible for the causal damage to the brain and therefore decides on the further course of treatment. If the primary disease is kidney failure, for example, treatment by dialysis or transplantation is possible. In principle, asterixis cannot be treated causally, because the damage to the brain has already taken place.
In most cases, the tissue of the brain is not able to regenerate completely. For this reason, it is usually not possible to eliminate the cause of an asterixis. However, the impairment can be improved by means of supportive treatment methods. The goal is always that the patient can lead as normal and self-determined a life as possible. Physiotherapy is usually used. Especially after a stroke, it is also possible to make the asterixis disappear by means of suitable treatment methods.
Outlook and prognosis
The prognosis of asterixis depends on the underlying disease. Spontaneous recovery from this disease cannot be assumed. Furthermore, there is a possibility that the symptoms of asterixis will not completely disappear even after the cause has been eliminated.
If it is a case of brain damage, this is to be regarded as irreversible according to the current state of medicine. Hand tremors can then only be reduced by administering medication. There are other side effects to watch out for.
In addition, there are therapeutic measures aimed at changing the movement sequences in everyday life and changing behavior. Through occupational or physical therapy, the patient learns to be able to continue living well despite the impairments. The integration of new coping strategies are taught to him step by step. Depending on the career choice, the patient can then go back to regular work.
Psychotherapeutic support can also be helpful. It should help to increase well-being and to gain courage. If the asterixis is due to renal insufficiency , dialysis is prescribed. This takes place at regular intervals and is intended to improve health.
In severe cases, a kidney transplant may be necessary. If this is successful, there is a high probability that the Asterixis can be cured.
Prevention
Asterixis can only be prevented by preventing metabolic damage to the brain or certain other diseases, such as cirrhosis of the liver. A risk-aware handling of toxic substances is therefore a possible measure to prevent asterixis.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.