History, Signs, and Symptoms
Patients with HE usually have advanced chronic liver disease and thus have many of the physical and laboratory stigmata associated with severe hepatic dysfunction.
The history may reveal a precipitating cause. These include:
Hypovolemia
Gastrointestinal bleeding
Hypokalemia and/or metabolic alkalosis
Hypoxia
Sedatives
Hypoglycemia
Infection (including spontaneous bacterial peritonitis)
Rarely, hepatocellular carcinoma and/or vascular occlusion (hepatic vein or portal vein thrombosis)
Disturbance in the diurnal sleep pattern (insomnia and hypersomnia) is common, and typically precedes overt neurologic signs. More advanced neurologic features include bradykinesia, asterixis (flapping motions of outstretched, dorsiflexed hands). Hyperactive deep tendon reflexes are common; seizures and hallucinations and transient decerebrate posturing may also be seen occasionally