Hepatic encephalopathy with reversible focal neurologic signs resembling acute stroke: case report

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Yoshiya YamamotoYasuo Katayama

Abstract

A 64-year-old female with a history of primary biliary cirrhosis and esophageal varices starting at age 39 was brought to our Stroke Care Unit by ambulance with right-side weakness and speech difficulty. Physical examination revealed right hemiparesis (including the face), sensory disturbances, pathological reflexes, and slightly decreased consciousness, with a Glasgow Coma Scale rating of E3V4M6. Flapping tremors and speech disturbance, as well as anarithmia, construction apraxia, and ideomotor apraxia, were noted, and her National Institutes of Health Stroke Scale score was 13. Initially, the patient was diagnosed with acute stroke and treated accordingly; however, subsequent findings from clinical images and electroencephalography led to a diagnosis of focal neurologic signs due to hepatic encephalopathy (HE). The patient had significantly reduced cerebral blood flow in the left side of the brain, probably due to microsurgical repair of an aneurysm done 2 years earlier. HE with exaggerated chronic liver damage might have made the previously silent ischemia clinically apparent. This interpretation is supported by the fact that the patient's neurologic deficits resolved once HE was adequately controlled. This case illustrates ...Continue Reading

References

Nov 1, 1995·European Journal of Gastroenterology & Hepatology·J F DillonP C Hayes
Aug 10, 2000·European Journal of Gastroenterology & Hepatology·G I StraussF S Larsen
Feb 18, 2004·Archives of Neurology·Katia MattarozziMaria Guarino
Nov 5, 2005·World Journal of Gastroenterology : WJG·Sergei MechtcheriakovWolfgang Vogel

❮ Previous
Next ❯

Citations

Jun 18, 2016·Current Treatment Options in Neurology·José M FerroPatrícia Santos
Jul 18, 2016·Journal of the Neurological Sciences·Tomomi ShijoMasashi Aoki
Jul 10, 2013·International Journal of Stroke : Official Journal of the International Stroke Society·Nadine AndrewDominique A Cadilhac
Jul 12, 2018·Epidemiology and Infection·Raffaella RomeoGiovanna Loquercio
Mar 6, 2019·SAGE Open Medicine·Sanath K Allampati, Kevin D Mullen
Dec 12, 2019·Case Reports in Neurology·Kyan YounesAmanda Jagolino-Cole

❮ Previous
Next ❯

Related Concepts

Related Feeds

Aneurysm

Aneurysms are outward distensions or bulges that occurs in a weakened wall of blood vessels. Discover the latest research on aneurysms here.

Acute Stroke

A stroke occurs when blood supply to the brain is interrupted depriving the brain of oxygen and nutrients. This feed focuses cerebrovascular accidents including ischemic and paralytic stroke.

Basal Ganglia

Basal Ganglia are a group of subcortical nuclei in the brain associated with control of voluntary motor movements, procedural and habit learning, emotion, and cognition. Here is the latest research.

Brain Ischemia

Brain ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. Discover the latest research on brain ischemia here.

Related Papers

Journal of Neurology, Neurosurgery, and Psychiatry
R SandykM W Erdmann
Journal of Neurology, Neurosurgery, and Psychiatry
M Fisher
Annals of Neurology
S NodaK Yamamoto
Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Thomas M HemmenPatrick D Lyden
Emergency Medicine Clinics of North America
J S Huff
© 2021 Meta ULC. All rights reserved