Hepatic encephalopathy history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

One of the earliest manifestations of hepatic encephalopathy is "day-night reversal". In other words, affected individuals tend to sleep during the day and stay awake at night. Another early manifestation is impairment in spatial perception. This can be made apparent by noting the patient's poor ability to copy or draw various simple images, e.g cube, star, clock. This deficit can also be demonstrated by administering a test which has the patient connect a number of randomly placed dots on a sheet of paper (the "trail test" or "numbers connecting test").

History and Symptoms

Symptoms many begin slowly and gradually worsen, or they may begin suddenly and be severe from the start. Symptoms may be mild at first. Family members or caregivers may notice that the patient has:

• Breath with a musty or sweet odor
• Change in sleep patterns
• Changes in thinking
• Confusion that is mild
• Forgetfulness
• Mental fogginess
• Personality or mood changes
• Poor concentration
• Poor judgment
• Worsening of handwriting or loss of other small hand movements

More severe symptoms may include:

• Abnormal movements or shaking of hands or arms
• Agitation, excitement, or seizures (occur rarely)
• Disorientation
• Drowsiness or confusion
• Inappropriate behavior or severe personality changes
• Slurred speech
• Slowed or sluggish movement

Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma. Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.