Hepatic encephalopathy; Alzheimer's type II astrocytes: The metabolic disorder of hepatic encephalopathy is characterized by the development of protoplasmic astrocytosis (hyperplasia of Alzheimer type II astrocytes). Astrocytic nuclei are enlarged, paired forms are frequent and nucleoli prominent. Structural changes in the neurons are absent. No glial scar is formed in protoplasmic astrocytosis. The paired nuclei in the lower part of the field in this slide exhibit the typical changes observed in this type of astrocytic response.