title: Status epilepticus as a manifestation of hepatic encephalopathy.
abstract: 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.
authors.affiliation: Gastroenterology Department AHEPA Hospital, Greece. pipinely@yahoo.com
authors.forename: N
authors.initials: N
authors.lastname: Eleftheriadis
authors.forename: E
authors.initials: E
authors.lastname: Fourla
authors.forename: D
authors.initials: D
authors.lastname: Eleftheriadis
authors.forename: A
authors.initials: A
authors.lastname: Karlovasitou
mesh_terms: 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
chemical_list: D000927:Anticonvulsants; D007792:Lactulose