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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hepatic encephalopathy.N Engl J Med. 2017; 376: 186
- Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure.Neurology. 1993; 43 (65-65)https://doi.org/10.1212/wnl.43.1_part_1.65
- MR imaging findings in hepatic encephalopathy.AJNR Am J Neuroradiol. 2008; 29: 1612-1621
- Increased blood manganese in cirrhotic patients: relationship to pallidal magnetic resonance signal hyperintensity and neurological symptoms.Hepatology. 1996; 24: 1116-1120
- MRI findings in chronic hepatic encephalopathy depend on portosystemic shunt: results of a controlled prospective clinical investigation.J Hepatol. 1997; 27: 121-126
- Portosystemic shunt syndrome and endovascular management of hepatic encephalopathy.Semin Intervent Radiol. 2014; 31: 262-265
- Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver.Hepatology. 2014; 60: 715-735
- Management of hepatic encephalopathy in the hospital.Mayo Clin Proc. 2014; 89: 241-253
- A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy.Am J Gastroenterol. 2013; 108: 1458-1463
- Embolization of portosystemic shunts for treatment of medically refractory hepatic encephalopathy.Liver Transpl. 2016; 22: 723-731https://doi.org/10.1002/lt.24440
- Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy.Hepatology. 2013; 57: 2448-2457https://doi.org/10.1002/hep.26314
Article info
Publication history
Published online: February 19, 2020
Thomas J. Marrie, MD, Section EditorFootnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
Published by Elsevier Inc.
