{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:03:12Z","timestamp":1756339392157,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,2,24]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2019-233046","type":"journal-article","created":{"date-parts":[[2020,3,13]],"date-time":"2020-03-13T05:19:25Z","timestamp":1584076765000},"page":"e233046","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Hepatic encephalopathy: a rare cause of focal seizures in chronic liver disease"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5382-9881","authenticated-orcid":false,"given":"Paul Jie Wen","family":"Tern","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Bryce","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Marelli","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aruchuna","family":"Ruban","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,12]]},"reference":[{"key":"2025082701190630000_13.3.e233046.1","doi-asserted-by":"publisher","DOI":"10.1097\/00004691-199705000-00008"},{"key":"2025082701190630000_13.3.e233046.2","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1111\/jgh.14558","article-title":"Serum sodium as a risk factor for hepatic encephalopathy in patients with cirrhosis and ascites","volume":"34","author":"Bossen","year":"2019","journal-title":"J Gastroenterol Hepatol"},{"key":"2025082701190630000_13.3.e233046.3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3988\/jcn.2016.12.1.21","article-title":"Acute symptomatic seizures caused by electrolyte disturbances","volume":"12","author":"Nardone","year":"2016","journal-title":"J Clin Neurol"},{"key":"2025082701190630000_13.3.e233046.4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.pediatrneurol.2017.09.013","article-title":"Antiepileptic drugs and liver disease","volume":"77","author":"Vidaurre","year":"2017","journal-title":"Pediatr Neurol"},{"key":"2025082701190630000_13.3.e233046.5","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.63.3.279"},{"key":"2025082701190630000_13.3.e233046.6","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i48.9240"},{"key":"2025082701190630000_13.3.e233046.7","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1034\/j.1600-0404.2003.02092.x","article-title":"Status epilepticus as a manifestation of hepatic encephalopathy","volume":"107","author":"Eleftheriadis","year":"2003","journal-title":"Acta Neurol Scand"},{"key":"2025082701190630000_13.3.e233046.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12876-016-0487-3","article-title":"Epilepsy as a risk factor for hepatic encephalopathy in patients with cirrhosis: a cohort study","volume":"16","author":"Jepsen","year":"2016","journal-title":"BMC Gastroenterol"},{"key":"2025082701190630000_13.3.e233046.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2014.02.002"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-233046","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:19:12Z","timestamp":1756282752000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-233046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":9,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3,12]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/bcr-2019-233046"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-233046","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}