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Case report
Hepatic encephalopathy: a rare cause of focal seizures in chronic liver disease
  1. Paul Jie Wen Tern,
  2. Kathleen Bryce,
  3. Laura Marelli and
  4. Aruchuna Ruban
  1. Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Paul Jie Wen Tern; paul.tern{at}


Hepatic encephalopathy (HE) is an extremely rare cause of focal seizures and is usually a diagnosis of exclusion when more commoner causes such as infection, autoimmune and malignancy have been discounted. The literature reports patients with generalised cerebral oedema and rarely status epilepticus, but these are often in the context of acute liver failure as opposed to chronic liver disease. Here we discuss a case of HE leading to focal neurological deficits and seizures in a 48-year-old woman with a background of chronic alcoholic liver disease. MRI scan showed extensive left-sided tempo-parietal-occipital cortical oedema and electroencephalogram showed widespread moderate HE with runs of epileptiform discharges. The treatment involves antiepileptic therapy as well as standard management of HE with laxatives, rifaximin and optimisation of nutrition.

  • liver disease
  • cirrhosis
  • neurogastroenterology
  • epilepsy and seizures

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  • Contributors PJWT wrote the draft manuscript and is the first author. AR came up with the idea of the manuscript, reviewed and edited the manuscript and is the senior author. KB and LM reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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