Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 5105-5109
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.5105
Nonconvulsive status epilepticus disguising as hepatic encephalopathy
Yong Min Jo, Sung Wook Lee, Sang Young Han, Yang Hyun Baek, Ji Hye Ahn, Won Jong Choi, Ji Young Lee, Sang Ho Kim, Byeol A Yoon
Yong Min Jo, Sung Wook Lee, Sang Young Han, Yang Hyun Baek, Ji Hye Ahn, Won Jong Choi, Ji Young Lee, Department of Internal Medicine, Dong-A University School of Medicine, Busan 602-715, South Korea
Sang Ho Kim, Byeol A Yoon, Department of Neurology, Dong-A University School of Medicine, Busan 602-715, South Korea
Author contributions: Jo YM and Lee SW performed the majority of clinical practice and experiments; Han SY and Baek YH provided the collection of all the patient medical records; Ahn JH and Choi WJ involved in editing the manuscript; Kim SH and Yoon BA interpreted electroencephalographic results of the patient; Jo YM and Lee JY wrote the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sung Wook Lee, MD, PhD, Department of Internal Medicine, Dong-A University School of Medicine, 3 Ga 1, Dongdaesin-dong, Seo-gu, Busan 602-715, South Korea. sunglee@dau.ac.kr
Telephone: +82-51-2405627 Fax: +82-51-2402087
Received: September 21, 2014
Peer-review started: September 26, 2014
First decision: October 14, 2014
Revised: November 20, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 28, 2015
Processing time: 217 Days and 24 Hours
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.