Hepatic encephalopathy

[From a successful poster.......]

Does a normal ammonia level necessarily rule out hepatic encephalopathy?  If I understand correctly, high ammonia is just one of suspected causes.  Therefore, would it be correct to assume that other circumstances in which the liver is not properly filtering toxins could cause hepatic encephalopathy as well?  

Thanks.

[CCF-Neuro-M.D.-JT]

Although ammonia levels are usually elevated somewhat in classic hepatic encephalopathy, a normal ammonia does not completely rule it out. In fact, a recent study showed that the actual level of ammonia does not correspond with the degree of encephalopathy, although the increased ammonia is thought to play some kind of role in neurological dysfunction with liver disease.  You are correct on your second point in that any kind of liver disease, if severe enough to compromise the liver's ability to metabolize things, can certainly lead to an encephalopathy.  We see this quite frequently at the CLeveland CLinic in patients who have Wilson's disease (a genetic liver disease), alcholic cirrhosis, or hepatitis in addition to other diseases that affect the liver. Hope that helps.

[From a successful poster.......]

Yes, that does help me understand somewhat.  Thank you.  

My gastroenterologist recently entertained the idea that my severe neurological "spells" (epidsodes of increasing talkativeness, which progresses to uncharacteristic rage, inability to read/write, not knowing where I am, ending with fatigue and drowsiness) may be caused by hepatic encephalopathy.  He felt that the chronic viral-like illness I'm experiencing, combined with the neurological "spells," might suggest liver dysfunction.  However, recent testing to support his suspicion came back normal (except for a high creatinine level..... not sure if that was serum or urine concentration of creatine.  Pretty sure it was urine.)

I was initially diagnosed with right temporal lobe epilepsy.  However, while my EEGs have never been completely normal, they are not grossly abnormal and vary in where the abnormalities are located.  First one had right temp. lobe spiking and slowing.  Second EEG showed frontal slowing, both right and left, but no spiking.   Third EEG showed distinct right temp. lobe slowing and occassional left temp. lobe slowing, but no spiking.  A subsequent outpatient 5-day EEG showed variations of all of the above - however I did not experience a "spell" during the testing.

Attempts to medicate me have fed the severity of the episodes instead of easing them.  My internist experimented with giving me trials of sedatives and anti-psychotics (Zyprexa) to see if they would take the edge off of the "spells."  This caused a startling increase in symptoms.  Which leads my gastroenterologist to believe that possibly my liver is not metabolizing correctly and is allowing toxins to "get to" my brain.  

Sorry to be so long-winded.  It's been a complicated journey through this illness.  Still no clear answers.  

Take care, doctor, and thank you for your service here.

[roxie]

Hello:  I belong to a group memebership for encephalitis survivors and their caregivers.  I also have daily headaches, and at least 5 migraines a week.  My neuro is trying to find the right combination of meds to 1) prevent the h/a  or at least make them mild enough to function 2) stabilize me so that I can process information and 3) Make my life more comfortable.  I survived viral menengoencephalitis in Sept 2000.  It took 8 months of going to UCLA, to other neurologists trying to get an answer as to what was wrong with me.  Everyone kept trying to treat the symptoms and not the disease.....and I was even told that I was crazy....because of the rage, depression, fatigue, headaches, and cranial pressure that I suffered from daily...I finally chose a doctor out of my insurance book, and I thank God for him every day, he has placed me on anti-depressants, Paxil has been the one that works for me, it took the edge off of my new personality after the accute stage of enceph, the swelling leaves you with a brain injury and this can leave you acting and feeling very different than prior to the virus, Good Luck, you can visit our site at ***@****  its a great support group.  Just my personal thoughts here, Roxie