■肝性脑病以精神和神经系统异常为特征,包括癫痫发作和非惊厥性和惊厥性癫痫持续状态。常规的脑磁共振成像可用于支持诊断,因为它可以揭示特定的放射学发现。在文学中,没有将肝性脑病的发病描述为非惊厥性癫痫持续状态;我们提供了第一份报告.
■我们报告一例67岁女性,没有肝硬化病史,表现出改变的精神状态,正常的大脑计算机断层扫描成像,脑电图提示癫痫活动。我们怀疑非惊厥性癫痫持续状态,我们给药地西泮和左乙拉西坦的临床改善。因此,我们诊断为非惊厥性癫痫持续状态.脑磁共振成像的放射学研究显示,苍白球的T1加权序列的双侧高强度和T2加权液体衰减的反转恢复序列的两个皮质脊髓束的高强度。血液检查显示高氨血症,肝功能指标轻度异常,以及慢性乙型和丁型肝炎病毒合并感染。肝弹性成像提示肝硬化。患者开始使用恩替卡韦进行抗病毒治疗,并使用利福昔明和乳果糖预防肝性脑病;她出院,精神状态正常。
■肝性脑病可表现为非惊厥性癫痫持续状态的初始表现。脑电图可用于区分非惊厥性癫痫持续状态和肝性脑病发作,和神经成像有助于诊断过程。
UNASSIGNED: Hepatic encephalopathy is characterized by psychiatric and neurological abnormalities, including epileptic seizure and non-convulsive and convulsive status epilepticus. Conventional brain magnetic resonance imaging is useful in supporting diagnosis since it can reveal specific radiological findings. In the literature, there is no description of hepatic encephalopathy onset as non-convulsive status epilepticus; we provide the first report.
UNASSIGNED: We report a case of a 67-year-old woman, without history of cirrhosis, presenting altered mental state, normal brain computed tomography imaging, and electroencephalography suggestive of epileptic activity. We suspected non-convulsive status epilepticus, and we administered diazepam and levetiracetam with clinical improvement. Thus, we made a diagnosis of non-convulsive status epilepticus. A radiological study with brain magnetic resonance imaging showed bilateral hyperintensity on T1-weighted sequences of globus pallidus and hyperintensity of both corticospinal tracts on T2-weighted fluid-attenuated inversion recovery sequences. Blood tests revealed hyperammonemia, mild abnormality of liver function indices, and chronic Hepatitis B and D virus coinfection. Hepatic elastosonography suggested liver cirrhosis. The patient started antiviral therapy with entecavir and prevention of hepatic encephalopathy with rifaximin and lactulose; she was discharged with a normal mental state.
UNASSIGNED: Hepatic encephalopathy can present as an initial manifestation with non-convulsive status epilepticus. Electroencephalography is useful for differentiating non-convulsive status epilepticus from an episode of hepatic encephalopathy, and neuroimaging aids the diagnostic process.