Nonconvulsive status epilepticus disguising as hepatic encephalopathy

Abstract

Nonconvulsive status epilepticus has become an important issue in modern neurology and epileptology. This is based on difficulty in definitively elucidating the condition and its various clinical phenomena and on our inadequate insight into the intrinsic pathophysiological processes. Despite nonconvulsive status epilepticus being a situation that requires immediate treatment, this disorder may not be appreciated as the cause of mental status impairment. Although the pathophysiology of nonconvulsive status epilepticus remains unknown, this disorder is thought to lead to neuronal damage, so its identification and treatment are important. Nonconvulsive status epilepticus should be considered in the differential diagnosis of patients with liver cirrhosis presenting an altered mental status. We report a case of a 52-year-old male with liver cirrhosis presenting an altered mental status. He was initially diagnosed with hepatic encephalopathy but ultimately diagnosed with nonconvulsive status epilepticus by electroencephalogram.

Keywords: Liver cirrhosis, Hepatic encephalopathy, Nonconvulsive status epilepticus, Electroencephalogram

Core tip: This case highlights the probability of nonconvulsive status epilepticus in patient with liver cirrhosis and the utility of electroencephalogram to evaluate for patient with liver cirrhosis who presents an altered mental status. It is important to consider the possibility of nonconvulsive status epilepticus, evaluating for patient with liver cirrhosis who presents with an altered mental status, especially who do not respond to empirical treatment.