Discussion
Both of our patients demonstrated signs and symptoms that largely
fit the HE diagnostic criteria proposed by Peschen-Rosin et al. in
1999 [4]. The criteria include the presence of unexplained myoclonus,
generalized seizures, psychiatric disorders, or focal neurological
findings, and three of the following: abnormal EEG, elevated thyroid
antibodies, elevated CSF protein, response to steroid treatment,
and unremarkable findings on brain MRI. HE symptomatology has
been expanded to include tremor and cognitive impairment, among
other findings [2]. It has been noted that only half of HE patients
exhibit a complete response to corticosteroid therapy; therefore,
unresponsiveness should not be used as an exclusion criterion [5].
The first patient’s predominant symptoms would best be categorized
as tremor and cognitive impairment, while the second patient’s main
manifestations were cognitive impairment and seizures. Both patients