Status epilepticus as an initial manifestation of hepatic encephalopathy:A case report  

作　　者：Bin Cui Lin Wei Wei Qu Zhi-Gui Zeng Ying Liu Zhi-Jun Zhu Li-Ying Sun 

机构地区：[1]Liver Transplantation Center,National Clinical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China [2]Liver Transplantation Center,National Clinical Research Center for Digestive Diseases,Intensive Care Unit,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China

出　　处：《World Journal of Clinical Cases》2020年第24期6480-6486,共7页世界临床病例杂志

基　　金：Supported by Beijing MunicipalScience & TechnologyCommission, No.Z181100001718220.

摘　　要：BACKGROUND Status epilepticus in patients with hepatic encephalopathy (HE) is a rare butserious condition that is refractory to antiepileptic drugs, and current treatmentplans are vague. Diagnosis may be difficult without a clear history of cirrhosis.Liver transplantation (LT) is effective to alleviate symptoms, however, there arefew reports about LT in the treatment of status epilepticus with HE. To ourknowledge, this is the first report of status epilepticus present as initialmanifestation of HE.CASE SUMMARY A 59-year-old woman with a 20-year history of heavy drinking was hospitalizedfor generalized tonic-clonic seizures. She reported no history of episodes of HE,stroke, spontaneous bacterial peritonitis, ascites or gastrointestinal bleeding.Neurological examination revealed a comatose patient, without papilledema.Laboratory examination suggested liver cirrhosis. Plasma ammonia levels uponadmission were five times normal. Brain computed tomography (CT) was normal,while abdominal CT and ultrasound revealed mild ascites, liver cirrhosis andsplenomegaly. Electroencephalography (EEG)showed diffuse slow waves rhythm,consistent with HE, and sharp waves during ictal EEG corresponding to clinicalsemiology of focal tonic seizures. The symptoms were reversed by continuousantiepileptic treatment and lactulose. She was given oral levetiracetam, and focalaware seizures occasionally affected her 10 mo after LT.CONCLUSION Status epilepticus could be an initial manifestation of HE. Antiepileptic drugs combined with lactulose are essential for treatment of status epilepticus with HE,and LT is effective to prevent the relapse.

关 键 词：Status epilepticus Hepatic encephalopathy Decompensated alcoholic liver cirrhosis Antiepileptic drugs Liver transplantation Case report 

分 类 号：R575.3[医药卫生—消化系统]