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

Abstract

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.

Newly Diagnosed Hepatic Encephalopathy Presenting as Non-convulsive Status Epilepticus: A Case Report and Literature Review

“…In particular, the description of NCSE in HE is anecdotal, probably because cognitive disturbances are shared in the two conditions, and an EEG is not always performed. To the best of our knowledge, just four case reports were previously described, and none of them reported NCSE as the first manifestation of HE ( 3 – 6 ). In our case, NCSE was diagnosed according to Salzburg criteria, since we found epileptiform discharge on the EEG that ceased after antiepileptic drugs administration, associated with a mental state improvement ( 15 ).…”

“…Considered a metabolic disorder, it is usually reversible by liver transplantation ( 1 ). Although rare, HE can present as epileptic seizure; manifestations vary widely, encompassing tonic-clonic seizure, convulsive (CSE), and non-convulsive status epilepticus (NCSE) ( 2 – 6 ). HE can show typical features on brain magnetic resonance imaging (MRI), namely, the bilateral and symmetric hyperintensity of the globus pallidus on T1-weighted (T1W) sequences, and hyperintensity in cerebral white matter, involving corticospinal tract and subcortical hemispheric white matter on T2 weighted (T2W)—“fluid attenuated inversion recovery” (FLAIR) MRI sequences ( 7 ).…”

Non-Convulsive Status Epilepticus in Hepatic Encephalopathy: A Case Series and Review of the Literature

“…This effect was even higher for admission with SE, with a three-to fivefold likelihood of admission with SE in the next 6 months [14] . Table 1 summarizes the four case reports found in PubMed, CINAHL and Web of Science [15][16][17][18] .…”