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*Vd. Sunil A. Bhaskare and Vd. Madhuri S. Jadhav


Hepatic encephalopathy is an altered level of consciousness as a result of liver failure. Onset may be gradual or sudden. Other symptoms may include movement problems, changes in mood, or changes in personality. In the advanced stages it can result in a coma. Hepatic encephalopathy can occur in those with acute or chronic liver disease. Episodes can be triggered by infections, GI bleeding, constipation, electrolyte problems, or certain medications. The underlying mechanism is believed to involve the buildup of ammonia in the blood, a substance that is normally removed by the liver. The diagnosis is typically made after ruling out other potential causes. It may be supported by blood ammonia levels, an electroencephalogram, or a CT scan of the brain. The symptoms of hepatic encephalopathy may also arise from other conditions, such as cerebral hemorrhage and seizures. In a small proportion of cases, the encephalopathy is caused directly by liver failure; this is more likely in acute liver failure. The mildest form of hepatic encephalopathy is difficult to detect clinically, but may be demonstrated on neuropsychological testing. It is experienced as forgetfulness, mild confusion, and irritability. The first stage of hepatic encephalopathy is characterized by an inverted sleep-wake pattern (sleeping by day, being awake at night). The second stage is marked by lethargy and personality changes. The third stage is marked by worsened confusion. The fourth stage is marked by a progression to coma. A male patient named XYZ of 65yrs old came in emergency with the diagnosis Hepatic Encephalopathy with subdural hematoma, the case is as follows-

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