Diagnosis and therapy of hepatic encephalopathy.

Abstract

The diagnosis of Hepatic Encephalopathy (HE) is basically clinical, and consists in the detection of various degrees of mental impairment along with neuromuscular abnormalities. Three components of mental state may be impaired in HE: the level of consciousness, personality (behavior), and the upper intellectual functions (1). The most common neuromuscular abnormality is the so-called asterixis or flapping tremor, however other signs or symptoms such as impaired handwriting are usually present in the lower degrees of HE, with this being impossible to explore in cases of coma flapping tremor; in this situation muscular rigidity and hyperreflexia are common. In Table 1 the most common classification of HE is described. This classification is clearly useful in cases of acute HE, but in cases of chronic HE the four different stages of HE are less clear. It is important to know the existence of subclinical HE in some patients with chronic liver disease with apparent normal mental status, and this may only be documented by certain psychometric tests (2). These patients may have problems when performing activities requiring a correct degree of mental and neuromuscular status, such as driving cars (3).