Tern Paul Jie Wen, Bryce Kathleen, Marelli Laura, Ruban Aruchuna
Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK.
BMJ Case Rep. 2020 Mar 12;13(3):e233046. doi: 10.1136/bcr-2019-233046.
Hepatic encephalopathy (HE) is an extremely rare cause of focal seizures and is usually a diagnosis of exclusion when more commoner causes such as infection, autoimmune and malignancy have been discounted. The literature reports patients with generalised cerebral oedema and rarely status epilepticus, but these are often in the context of acute liver failure as opposed to chronic liver disease. Here we discuss a case of HE leading to focal neurological deficits and seizures in a 48-year-old woman with a background of chronic alcoholic liver disease. MRI scan showed extensive left-sided tempo-parietal-occipital cortical oedema and electroencephalogram showed widespread moderate HE with runs of epileptiform discharges. The treatment involves antiepileptic therapy as well as standard management of HE with laxatives, rifaximin and optimisation of nutrition.
肝性脑病（HE）是局灶性癫痫发作极为罕见的病因，当排除感染、自身免疫性疾病和恶性肿瘤等更常见病因后，通常可诊断为此病。文献报道有患者出现全身性脑水肿，很少有癫痫持续状态的情况，但这些情况多发生在急性肝衰竭背景下，而非慢性肝病。在此，我们讨论一例患有慢性酒精性肝病的48岁女性，其肝性脑病导致局灶性神经功能缺损和癫痫发作。磁共振成像（MRI）扫描显示左侧颞顶枕叶皮质广泛水肿，脑电图显示广泛中度肝性脑病并伴有癫痫样放电。治疗包括抗癫痫治疗以及使用泻药、利福昔明对肝性脑病进行标准管理并优化营养。
