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Status epilepticus as a manifestation of hepatic encephalopathy


N. Eleftheriadis, Politechniu 3 Triandria, 55337 Thessaloniki, Greece
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Objectives– Seizures have been described as a rare manifestation of hepatic encephalopathy. Material and Methods– We present a 54-year-old female, with 6-year history of decompensated, hepatitis B liver cirrhosis, admitted with generalized seizures. She reported a history of recurrent episodes of hepatic encephalopathy, spontaneous bacterial peritonitis, tense ascites and variceal hemorrhage. Neurologic examination revealed a comatose patient, without papilledema. Laboratory examinations were suitable with cirrhosis and mild renal failure. Blood gas examination revealed severe metabolic acidosis and hypoxemia. Plasma NH3+ levels upon admission were twice normal. Brain computed tomography and magnetic resonance imaging were normal. Electroencephalogram showed diffuse sharp waves, consistent with hepatic encephalopathy, grades III–IV. Results– Status epilepticus was refractory to continuous antiepileptic treatment. However, it was resolved after 24-h therapy with lactulose. Blood NH3 levels were simultaneously normalized with clinical improvement. Conclusions– We consider the status epilepticus of our patient to be a rare manifestation of hepatic encephalopathy.

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