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Oxidative stress can lead to lipid peroxidation, a process in which ROS react with lipids in cell membranes, resulting in the formation of lipid peroxides and aldehydes such as malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE) [9]

Hence, with the permeability in the blood-brain barrier and the vulnerability to the hyperammonemic and inflammatory environment, low-grade edema and oxidative/nitrosative stress are produced, with astrocytic dysfunction.71 New therapeutic targetsManganese-chelating agents Based on the evidence suggesting the involvement of manganese in the death of dopaminergic cells and its accumulation reported in the brain tissue of cirrhotic patients, it is not illogical to think that manganese chelators could aid in lowering the rates of parkinsonism associated with cirrhosis and in reducing the expression of oxidative stress radicals produced by their interaction with the microglia

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