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  1. Mark A Ellul1,2,
  2. Timothy J Cross3,
  3. Andrew J Larner4
  1. 1Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
  2. 2Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  3. 3Department of Hepatology, Royal Liverpool University Hospital, Liverpool, UK
  4. 4Cognitive Function Clinic, The Walton Centre NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Mark A Ellul, Department of Neurology, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; ellulm{at}


Adams and Foley described asterixis in the 1940s in patients with hepatic encephalopathy, but it has since been associated with a wide range of potential causes, both in neurology and general medicine. Here, we review the history, characteristics and clinical significance of this important clinical sign.

  • asterixis
  • encephalopathy
  • hepatic encephalopathy

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  • Contributors MAE and AJL both contributed to literature review, writing and editing of the manuscript. TJC helped with the patient video and reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by David Nicholl, Birmingham, UK.

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