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Hepatic encephalopathy with status epileptics: a case report
Hiroto Tanaka1, Hiroki Ueda, Yohei Kida
1Third Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0015, Japan. hgvttv1@r5.dion.ne.jp
World Journal of Gastroenterology
|April 6, 2006
Summary
This case study highlights a rare instance of severe hepatic encephalopathy manifesting as status epilepticus in a patient with liver cirrhosis. Prompt treatment with antiepileptics and branched-chain amino acids resolved the condition and normalized ammonia levels.
Area of Science:
- Hepatology
- Neurology
- Critical Care Medicine
Background:
- Decompensated liver cirrhosis, often caused by hepatitis C virus, can lead to severe complications.
- Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver dysfunction, typically presenting with altered mental status.
- Status epilepticus, a prolonged seizure, is an uncommon manifestation of HE.
Observation:
- A 62-year-old male with hepatitis C-induced liver cirrhosis presented with severe HE and status epilepticus.
- Elevated blood ammonia levels (over twice normal) were noted on admission.
- Brain imaging was normal, but EEG revealed diffuse sharp waves indicative of HE.
Findings:
- Status epilepticus was successfully treated with phenytoin sodium and branched-chain amino acids (BCAAs).
- Clinical improvement correlated with normalization of blood ammonia levels.
- The patient experienced no recurrence of status epilepticus, and EEG normalized post-treatment.
Implications:
- This case underscores that status epilepticus, though rare, can be a presenting feature of severe hepatic encephalopathy.
- Effective management involves addressing both the underlying HE and the seizure activity.
- Early diagnosis and combined therapeutic strategies are crucial for favorable outcomes in such complex cases.