Hepatic Encephalopathy Uncommonly Presenting by Epilepsy and Hemiparesis: A Case Report
Osama Helmy *
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Fouad Haddad
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Soukaina Banani
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Fatima Zahra EL Rhaoussi
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Mohamed Tahiri
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Wafaa Hliwa
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Ahmed Bellabah
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Wafaa Badre
Hepatology and Gastroenterology Department, UHC Ibn Rochd, Casablanca, Morocco.
Ait Lahcen Karima
Neurology Department, UHC Ibn Rochd, Casablanca, Morocco.
El Otmani Hicham
Neurology Department, UHC Ibn Rochd, Casablanca, Morocco.
Rafai Mohammed Abdou
Neurology Department, UHC Ibn Rochd, Casablanca, Morocco.
Ghizlane Lembarki
Central Unit of Radiology, UHC Ibn Rochd, Casablanca, Morocco.
El Oualladi Feryal
Central Unit of Radiology, UHC Ibn Rochd, Casablanca, Morocco.
Lezar Samira
Central Unit of Radiology, UHC Ibn Rochd, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Hepatic encephalopathy (HE) is a serious complication of cirrhosis that presents with a variety of neuropsychiatric disorders, including disorientation, asterixis and coma. Such neurological disorders are because of hyperammonemia. However, hepatic encephalopathy with neurological symptoms resembling epilepsy and hemiparesis is uncommon. We present a case of decompensated liver cirrhosis manifesting initially by epilepsy and hemiparesis.
Case Report: A 59-year-old male smoker known to be diabetic, which was well controlled, presented to our hospital with a chief complaint of epileptic attacks over the past 24 hours in addition to dizziness, sudden-onset left-sided weakness and disturbed level of consciousness with a Glasgow Coma Scale rating of 13. Brain CT scan and MRI revealed supratentorial white matter changes with no signs of stroke or bleeding. Electroencephalogram (EEG) showed diffuse slow wave rhythm. Initially, the patient was treated with antiepileptic drugs with no improvement. Laboratory examination suggested liver cirrhosis. Plasma ammonia levels upon admission were 2 times the normal value. Abdominal imaging showed chronic hepatopathy, portosystemic varices and splenomegaly. Upper endoscopy showed esophageal varices. Liver cirrhosis was confirmed by transient elastography. The aetiology of cirrhosis was considered metabolic. As a result, the diagnosis of HE was made. The symptoms were improved by adding lactulose and Rifaximin to antiepileptic treatment.
Conclusion: Though uncommon, hepatic encephalopathy, as a complication of liver cirrhosis, should be considered in patients presenting with epilepsy and hemiparesis. Antiepileptic drugs combined with lactulose are essential for treatment.
Keywords: Hepatic encephalopathy, liver cirrhosis, epilepsy, hemiparesis