Neurology Department, Faro Hospital, Faro, Portugal.
Epileptic Disord. 2013 Jun;15(2):207-10. doi: 10.1684/epd.2013.0575.
Hyperammonaemic encephalopathy is a rare and potentially fatal complication of valproic acid treatment. The clinical presentation of hyperammonaemic encephalopathy is wide and includes seizures and coma. We present a case of hyperammonaemic coma precipitated by sodium valproate use for symptomatic epilepsy in a patient with unrecognised portosystemic shunt, secondary to earlier alcoholism. The absence of any stigmata of chronic liver disease and laboratory markers of liver dysfunction delayed the recognition of this alcohol-related complication. The portal vein bypass led to a refractory, valproic acid-induced hyperammonaemic coma. The patient fully recovered after dialysis treatment.
高氨血症性脑病是丙戊酸治疗的一种罕见且潜在致命的并发症。高氨血症性脑病的临床表现广泛，包括癫痫发作和昏迷。我们报告了一例因门腔静脉分流引起的高氨血症性昏迷，患者因症状性癫痫使用丙戊酸钠治疗，而门腔静脉分流在之前的酒精中毒时未被发现。缺乏任何慢性肝病的特征和肝功能障碍的实验室标志物，导致对这种与酒精有关的并发症的识别延迟。门静脉旁路导致难治性、丙戊酸诱导的高氨血症性昏迷。透析治疗后，患者完全康复。
