Status epilepticus as a manifestation of hepatic encephalopathy.
OBJECTIVE
Seizures have been described as a rare manifestation of hepatic encephalopathy.


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.
Eleftheriadis
N
N
Gastroenterology Department AHEPA Hospital, Greece. pipinely@yahoo.com
Fourla
E
E
Eleftheriadis
D
D
Karlovasitou
A
A
D000138:Acidosis / Q000209:etiology; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007792:Lactulose / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications; D008875:Middle Aged; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
D000927:Anticonvulsants; D007792:Lactulose