Electro-Radiological Observations of Grade III/IV Hepatic Encephalopathy Patients with Seizures

Newey, Christopher R.; George, Pravin; Sarwal, Aarti; So, Norman K.; Hantus, Stephen

doi:10.1007/s12028-017-0435-2

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…Acute hepatic failure was suggested as a potential cause for SE in this case. Indeed, SE may occur during Grade III‐IV hepatic encephalopathy and acute liver failure [7]. In our case, normalization of liver function tests and ammonia levels were obtained before SE onset, suggesting an alternative diagnosis.…”

Section: Discussionmentioning

confidence: 50%

Status epilepticus after gastric bypass surgery

Sedano

Daoud

Marmol

et al. 2022

Epileptic Disorders

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Section: Discussionmentioning

confidence: 50%

Status epilepticus after gastric bypass surgery

Sedano

Daoud

Marmol

et al. 2022

Epileptic Disorders

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“…And the clinical improvement by propofol pump supported our diagnosis. In addition, some specific findings in diffusion-weighted imaging sequences of magnetic resonance imaging (MRI) (cortical or subcortical hyperintensity) may also support the diagnosis of SE[4]. In our case, the consciousness of the patient recovered to his usual status without sequela.…”

Section: Discussionmentioning

confidence: 61%

Propofol pump controls nonconvulsive status epilepticus in a hepatic encephalopathy patient: A case report

Hor

Chen

Tsai

2019

WJCC

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BACKGROUNDStatus epilepticus is an emergent and critical condition which needs management without hesitation. Nonconvulsive status epilepticus (NCSE) tends to be less recognized, and its diagnosis is delayed in comparison with overt status epilepticus because of the absence of specific clinical signs. It is often difficult to make a diagnosis, particularly in patients with hepatic encephalopathy.CASE SUMMARYA 38-year-old man with a history of alcoholic liver cirrhosis presented with altered mental status; the initial diagnosis was hepatic encephalopathy. Although optimal treatment for hepatic encephalopathy was administered, the patient's mental status did not improve. A final diagnosis of NCSE was made by continuous electroencephalogram (EEG) monitoring. Treatment with levetiracetam and propofol pump was immediately started. The patient’s consciousness gradually improved after discontinuation of propofol therapy, and no further epileptic discharge was observed by EEG monitoring. After 1 wk, the patient returned to full consciousness, and he was able to walk in the hospital ward without assistance. He was discharged with minimal sequela of bilateral conjunctivitis.CONCLUSIONIn cases of persistent altered mental status without reasonable diagnosis, NCSE should be considered in hepatic encephalopathy patients with persistently altered levels of consciousness, and EEG monitoring is very important. We also recommend propofol as a safe and efficient therapy for NCSE in liver cirrhosis patients.

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“…The incidence of nonconvulsive status epilepticus in patients with liver cirrhosis is rare. However, there is evidence that it is important to consider the possibility of nonconvulsive status epilepticus, especially in high-grade HE (30)(31)(32). Studies have also shown that cerebral dysrhythmias often appear on the EEG as focal or generalized spikes/sharp wave discharges that resemble epileptic discharges.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalogram in cirrhotic children without clinical encephalopathy

Shahramian,

Mohammadi,

Aminisefat

et al. 2024

Preprint

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Introduction Cirrhosis is one of the most common causes of hospitalization and death in children, so prevention of progressive liver diseases such as hepatic encephalopathy (HE) is critical. In addition to overt HE, subclinical hepatic encephalopathy (SHE) and mild hepatic encephalopathy (MHE) are stages of HE that can only be diagnosed by psychometric and neurophysiological tests, and with early diagnosis and treatment, daily functioning of patients will improve. Therefore, purpose of this study is determining electroencephalogram (EEG) findings in children with cirrhosis without clinical encephalopathy. Methods This study was conducted observationally at Amir Al Momenin Zabol Hospital, Zabol University of Medical Sciences, Iran. In this study, 50 children with cirrhosis without encephalopathy symptoms and 50 healthy children were examined for abnormal electroencephalogram findings. Finally, the data were analyzed using SPSS V22 software. Results The mean and standard deviation of study population age was 57.6 ± 76.17 months. Of a total of 50 children with cirrhosis, 21 (42%) had abnormal EEG findings, whereas no child in the healthy group had abnormal EEG findings. There was a significant association between abnormal EEG findings and older age (P = 0.001), underlying autoimmune hepatitis disease (P = 0.011), and abnormal (elevated) serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) .Children with cirrhosis who had abnormal EEG findings had a higher mean Pediatric End-Stage Liver Disease (PELD) score (18.1 ± 4.1) than patients with normal EEG findings (17.2 ± 3.7), but these findings was not statistically significant or remarkable ( P = 0.073). The sensitivity of EEG for predicting the severity of cirrhosis was estimated to be 70% and the specificity to be 65%. Conclusion The results of this study demonstrate that the higher sensitivity of EEG compared to the specificity in predicting the severity of cirrhosis indicates that EEG can be used to exclude severe cirrhosis or to screen cirrhotic patients at risk of deterioration than in confirming its diagnosis.

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Electro-Radiological Observations of Grade III/IV Hepatic Encephalopathy Patients with Seizures

Abstract: Seizures or status epilepticus in the setting of HE were without clinical findings and could go unrecognized without CEEG. The finding of cortical hyperintensity on MRI should lead to further evaluation for unrecognized seizure or status epilepticus.

Cited by 9 publications

References 31 publications

Status epilepticus after gastric bypass surgery

Status epilepticus after gastric bypass surgery

Propofol pump controls nonconvulsive status epilepticus in a hepatic encephalopathy patient: A case report

Electroencephalogram in cirrhotic children without clinical encephalopathy

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