Hepatic encephalopathy reflects a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction.
A 62 year old male was admitted to our neurology policlinic with progressive cognitive impairement lasting for a year. No abnormality was detected in his systemic and neurological examination except time disorientation. His cranial MRI demonstrated high signal intensity in the bilateral globus pallidus on T1-weighted images and high signal intensity along the hemispheric white matter on FLAIR-T2-weighted images. Also diffusion restriction was seen in bilateral centrum semiovale. Laboratory data showed thrombopenia, increased transaminase and gamma glutamyl transferase, decreased albumin levels. The plasma ammonia level was high. Abdominal echosonography and CT revealed atrophic cirrhotic liver and splenomegaly. EEG was associated with low-frequency waves in both hemispheres. His detailed neuropsychiatric evaluation revealed severe cognitive impairment. In combination with laboratory and radiological data, hepatic encephalopathy was suspected.
In conclusion, in a 62 year old male without any pathologic systematic or neurological examination findings, subclinic hepatic encephalopathy can be seen with progressive cognitive impairment. By presenting this case, we aimed to keep in mind the diagnosis of subclinic hepatic encephalopathy especially in elderly people with progressive cognitive impairment.
Key words: Hepatic encephalopathy, cognitive impairment, cranial magnetic resonance
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