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Complex partial non-convulsive status epilepticus masquerading as hepatic encephalopathy: a case report
Maaz B Badshah1, Haris Riaz, Sana Aslam
1Civil Hospital Karachi, Karachi, Pakistan. harisriaz73@yahoo.com.
Journal of Medical Case Reports
|December 19, 2012
Summary
Non-convulsive status epilepticus can mimic hepatic encephalopathy in cirrhotic patients. Prompt diagnosis and anti-convulsive therapy led to dramatic recovery, highlighting the need for broader differential diagnoses.
Area of Science:
- Neurology
- Hepatology
Background:
- Hepatic encephalopathy (HE) is a common complication in cirrhotic patients presenting with neuropsychiatric symptoms.
- Standard empiric therapy for HE includes lactulose and rifaximin.
Purpose of the Study:
- To report a case of non-convulsive status epilepticus (NCSE) misdiagnosed as HE.
- To emphasize the importance of considering NCSE in refractory HE cases.
Main Methods:
- A case report of a 45-year-old male with HCV cirrhosis and HIV.
- Initial presentation with confusion and altered mental status, treated empirically for HE without response.
- Diagnosis of NCSE confirmed by electroencephalogram (EEG) and treated with levetiracetam.
Main Results:
- The patient, initially diagnosed with HE, did not improve with standard treatment.
- EEG revealed seizure activity indicative of NCSE.
- Anti-convulsive therapy resulted in rapid improvement and sustained recovery.
Conclusions:
- NCSE should be included in the differential diagnosis for patients with suspected HE unresponsive to empirical treatment.
- Further research is warranted to determine the incidence of NCSE in patients with persistent HE.
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