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A Confusing Picture: Refractory Encephalopathy Complicating Nonalcoholic Steatohepatitis

Published:February 19, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.01.026
      A 72-year-old veteran with a past medical history of nonalcoholic steatohepatitis with compensated cirrhosis, history of grade 1 esophageal varices managed medically, diabetes mellitus, and coronary artery disease, presented to the emergency department (ED) with increasing confusion. He had been seen by his primary care provider 1 week prior to the onset of symptoms without any complaints and had been working on his roof to clean out the gutters 4 days before coming to the ED. According to his family, the patient began to perseverate on his computer and became progressively less interactive with his family over the 3 days prior to coming into the ED. His speech became slurred and ultimately unintelligible, and he appeared to see things that were not present to others. His family also noted that he seemed to have new tremors in both of his arms over the 2 days prior to admission. He was brought to the ED for further management.
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