Non-Hepatic Coma in a Cirrhotic Patient due to Chronic Subdural Hematoma

Abstract

Hepatic encephalopathy is the most frequent cause of altered mental status and coma in cirrhotic patients. In this report we describe an interesting case of a differential diagnostic pitfall, where a cirrhotic patient with compromised mental status initially supposed to suffer from hepatic encephalopathy turned out to have a non-traumatic chronic subdural hematoma. The major points leading to diagnosis were almost normal ammonia, hypertension and deteriorating overall condition despite targeted therapy of hepatic encephalopathy. In comatose cirrhotic patients with normal ammonia and hypertension intracranial hemorrhage should be excluded.