Interference with cerebral energy metabolism due to excess ammonia has been postulated as a cause of hepatic encephalopathy. Furthermore, consideration of the neurologic basis of such features of hepatic encephalopathy as asterixis, decerebrate rigidity, hyperpnea, and coma suggests a malfunction of structures in the base of the brain and their cortical connections. The three major sources of i...

Introduction: Severe COVID-19 infection is associated with significant mortality in the elderly. This even more so, when elderly patient disease also has multiple chronic co-morbidities, and resident a resource-constrained area.
 Aims/ Objectives: To outline management strategies employed, important lessons learnt from successful of case severe 93-year-old co-morbidities resource-limited s...

THE neuropsychiatric disturbances occurring in patients with liver disease have been recognized since the time of the Babylonians (Sherlock, I958). Only in the last ten years, however, have their clinical and biochemical significances been appreciated (Walshe, I95 I) (Adams and Foley, 1953). The clinical and EEG findings have been described in detail by Sherlock (I955), Davidson and Summerskill...

Oxaliplatin-based chemotherapy is widely used to treat advanced cancer. Oxaliplatin-induced hyperammonemic encephalopathy is rarely reported. Here, we report a case of oxaliplatin-induced hyperammonemic encephalopathy occurring after gemcitabine plus oxaliplatin (GEMOX) chemotherapy in a patient with pancreatic cancer. A 76-year-old man received GEMOX regimen as first-line treatment for pancrea...

OBJECTIVE Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. METHODS One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards wer...

A 39-yr-old male with hepatorenal syndrome type 1 and refractory ascites was treated with continuous renal replacement therapy (CRRT) resulting in clinical improvement. He was positive for antibodies to hepatitis B, C, and human immunodeficiency viruses, and had a history of chronic alcohol and iv drug abuse. The patient had 4 hospital admissions during a 12-wk period. He first presented with a...

Hepatic encephalopathy (HE) is a major neuropsychiatric complication of cirrhosis. HE develops slowly in cirrhotic patients, starting with altered sleep patterns and eventually progressing through asterixis to stupor and coma. Precipitating factors are common and include an oral protein load, gastrointestinal bleeding and the use of sedatives. HE is common following transjugular intrahepatic po...

A 72-year-oldwomanwith a history of end-stage liver disease (Child class A) secondary to cryptogenic cirrhosis presented for elective transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Recent imaging demonstrated increased size of a hypervascular 1.3-cm nodule in the left lobe consistent with recurrence at the margin of a previous radiofrequency ablation site. She reporte...

A 42-year-old man presented to the emergency department with 2 weeks history of fatigue and dark tarry stool. He had past medical history significant for primary sclerosing cholangitis with liver cirrhosis, complicated with ascites and small nonbleeding esophageal varices. He denied nausea, vomiting, abdominal pain, weight loss or change in appetite. He also denied excessive use of non-steroid ...

asthma, depression and moderate-toheavy consumption of alcohol had presented to the emergency department with a threemonth history of increasing fatigue and jaundice. She had reported consuming three or four beers on a regular basis and a few glasses of wine three times weekly. Over the past three months, she had been taking six prescription medications (Table 1) and seven natural health produc...