Hepatic encephalopathy differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Hepatic encephalopathy must be differentiated from other diseases that cause personality changes, altered level of consciousness and jerking movement of the limbs(asterixis) such as, complicated alcohol withdrawal, Wernicke encephalopathy, alcohol intoxication, metabolic abnormalities(hypoglycemia, electrolyte imbalance, hypercarbia, and uremia) ,toxic encephalopathy from drugs(sedative, salicylates, antidepressants and antipsychotic drugs), altered intracranial pressure(intracranial tumors, ,subdural hematoma, intracranial bleeding and abscesses), intoxication by chemical agents, malnutrition, hypoxia of brain, and sever intracranial or systemic infections(meningitis and encephalitis).
Differentiating Hepatic Encephalopathy from other Diseases
Hepatic encephalopathy must be differentiated from other diseases that cause personality changes, altered level of consciousness and hand tremors (asterixis). The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11]
| Diseases | History and Symptoms | Physical Examination | Laboratory Findings | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Personality changes | Altered level of consciousness | Hand tremors (asterixis) | Slurred speech | Writing disturbances | Voice monotonous | Impaired memory | Elevated blood ammonia | Hyponatremia | hypokalemia | |
| Hepatic encephalopathy | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ |
| Alcohol intoxication | + | + | -/+ | ++ | + | - | + | - | -/+ | -/+ |
| Alcohol withdrawal | + | + | - | ++ | + | - | + | - | -/+ | -/+ |
| Uremia | ++ | ++ | + | -/+ | -/+ | -/+ | - | ++ | Hyperkalemia | |
| Wernicke encephalopathy | + | + | -/+ | + | + | + | ++ | - | - | - |
| Toxic encephalopathy from drugs | + | + | -/+ | -/+ | + | -/+ | + | + | -/+ | -/+ |
| Altered intracranial pressure | + | -/+ | - | -/+ | -/+ | - | -/+ | - | - | - |
| Intoxication by chemical agents | -/+ | -/+ | -/+ | -/+ | -/+ | - | - | - | -/+ | -/+ |
| Malnutrition | -/+ | - | - | - | -/+ | - | -/+ | - | -/+ | -/+ |
| Hypoxic brain injury | - | -/+ | - | -/+ | -/+ | -/+ | -/+ | - | - | - |
| Meningitis and encephalitis | -/+ | -/+ | - | -/+ | + | - | - | - | -/+ | - |
| Hypoglycemia | -/+ | -/+ | - | -/+ | -/+ | - | - | - | -/+ | -/+ |
References
- ↑ Meparidze MM, Kodua TE, Lashkhi KS (2010). "[Speech impairment predisposes to cognitive deterioration in hepatic encephalopathy]". Georgian Med News (181): 43–9. PMID 20495225.
- ↑ Kattimani S, Bharadwaj B (2013). "Clinical management of alcohol withdrawal: A systematic review". Ind Psychiatry J. 22 (2): 100–8. doi:10.4103/0972-6748.132914. PMC 4085800. PMID 25013309.
- ↑ Roldán J, Frauca C, Dueñas A (2003). "[Alcohol intoxication]". An Sist Sanit Navar. 26 Suppl 1: 129–39. PMID 12813481.
- ↑ Seifter JL, Samuels MA (2011). "Uremic encephalopathy and other brain disorders associated with renal failure". Semin Neurol. 31 (2): 139–43. doi:10.1055/s-0031-1277984. PMID 21590619.
- ↑ Handler CE, Perkin GD (1983). "Wernicke's encephalopathy". J R Soc Med. 76 (5): 339–42. PMC 1439130. PMID 6864698.
- ↑ Kim Y, Kim JW (2012). "Toxic encephalopathy". Saf Health Work. 3 (4): 243–56. doi:10.5491/SHAW.2012.3.4.243. PMC 3521923. PMID 23251840.
- ↑ Hartmann A, Buttinger C, Rommel T, Czernicki Z, Trtinjiak F (1989). "Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension". Neurochirurgia (Stuttg). 32 (2): 37–43. doi:10.1055/s-2008-1053998. PMID 2497395.
- ↑ Kumar N (2011). "Acute and subacute encephalopathies: deficiency states (nutritional)". Semin Neurol. 31 (2): 169–83. doi:10.1055/s-0031-1277986. PMID 21590622.
- ↑ Chiu GS, Chatterjee D, Darmody PT, Walsh JP, Meling DD, Johnson RW; et al. (2012). "Hypoxia/reoxygenation impairs memory formation via adenosine-dependent activation of caspase 1". J Neurosci. 32 (40): 13945–55. doi:10.1523/JNEUROSCI.0704-12.2012. PMC 3476834. PMID 23035103.
- ↑ Peate I (2004). "An overview of meningitis: signs, symptoms, treatment and support". Br J Nurs. 13 (13): 796–801. doi:10.12968/bjon.2004.13.13.13501. PMID 15284663.
- ↑ Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ (2015). "Hypoglycemia in older people - a less well recognized risk factor for frailty". Aging Dis. 6 (2): 156–67. doi:10.14336/AD.2014.0330. PMC 4365959. PMID 25821643.