HE can be described as a continuum ranging from subtle psychomotor changes with intact consciousness to coma arising in patients with impaired liver function or portosystemic shunting. Neurological features of HE include:
- psychomotor slowing - is the first neuropsychological feature seen in HE patients.
- this can only be detected on psychometric testing
- subtle cognitive impairment and difficulties in concentration –
- trivial lack of awareness
- euphoria or anxiety
- impairment of addition or subtraction (for example, serial 7s test)
- reversal of the sleep-wake cycle – early sign in some patients
- affective changes including depression and occasionally personality changes are observed (such as irritability and inappropriate behaviour)
- agitation and aggression can progress to acute confusion leading to progressive stupor and coma.
- asterixis ( “liver flap”)
- an arrhythmic negative myoclonus and loss of postural tone with a frequency of 3-5 Hz
- may be bilateral or asymmetric
- normally seen in the hands but can affect other parts of the body.
- may be more easily felt than seen
The condition improves in association with improvement in liver function.
- (1) Ellul MA, Gholkar SA, Cross TJ.Hepatic encephalopathy due to liver cirrhosis. BMJ. 2015;351:h4187.
Last reviewed 01/2018