clinical features

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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.


Last reviewed 01/2018