Hepatic encephalopathy with status epileptics: a case report.
A 62-year-old male with decompensated liver cirrhosis due to hepatitis C virus developed severe hepatic encephalopathy with status epilepticus. The blood ammonia level on admission was more than twice the normal level. Brain computed tomography and magnetic resonance imaging were normal. In addition, electroencephalogram showed diffuse sharp waves, consistent with hepatic encephalopathy. The status epilepticus was resolved after antiepileptic therapy (phenytoin sodium) and treatment for hepatic encephalopathy (Branched chain amino acids). The blood ammonia level normalized with the clinical improvement and the patient did not have a recurrence of status epilepticus after the end of the antiepileptic treatment. Additionally, the electroencephalogram showed normal findings. Thus, we diagnosed the patient as hepatic encephalopathy with status epilepticus. We consider the status epilepticus of this patient to a rare and interesting finding in hepatic encephalopathy.
Third Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-0015, Japan. hgvttv1@r5.dion.ne.jp
Hiroto
H
Tanaka
Hiroki
H
Ueda
Yohei
Y
Kida
Hiroko
H
Hamagami
Tomikimi
T
Tsuji
Masakazu
M
Ichinose
D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D000641:Ammonia / Q000097:blood; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use; D013226:Status Epilepticus / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
D000597:Amino Acids, Branched-Chain; D010672:Phenytoin; D000641:Ammonia