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Hepatic Encephalopathy Induced Transient Cortical Blindness.

Shweta Pokhrel1, Pramesh Sunder Shrestha1, Rahul Pathak2

  • 1Department of Critical Care Medicine, Om Hospital and Research Centre, Chabahil, Kathmandu, Nepal.

Journal of Nepal Health Research Council
|August 10, 2022
PubMed
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Hepatic encephalopathy, a complication of severe liver dysfunction, can rarely cause cortical blindness. Prompt treatment of the underlying liver condition led to visual recovery in a patient with end-stage liver disease.

Area of Science:

  • Neurology
  • Hepatology
  • Ophthalmology

Background:

  • Hepatic encephalopathy (HE) encompasses neuropsychiatric changes linked to severe liver dysfunction and portosystemic shunting.
  • Cortical blindness is an uncommon but recognized neurological manifestation of HE.
  • This condition can manifest before other typical signs of altered consciousness.

Observation:

  • A 57-year-old female with chronic liver disease presented with sudden bilateral vision loss.
  • Initial examination revealed no focal neurological deficits, with papilledema noted.
  • Clinical and laboratory findings supported a diagnosis of HE-induced cortical blindness.

Findings:

  • The patient's visual disturbances resolved with targeted treatment for hepatic encephalopathy.

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  • This case highlights the potential for visual impairment as a presenting symptom of HE.
  • Successful management of the underlying liver disease reversed the cortical blindness.

    • Implications:

    • Cortical blindness should be considered in the differential diagnosis of visual loss in patients with advanced liver disease.
    • Early recognition and management of HE are crucial for potentially reversible neurological deficits, including visual disturbances.
    • This case underscores the importance of a multidisciplinary approach in managing complex liver disease complications.