Reversible hepatic decerebration: a case report and review of the literature

Abstract

Hepatic encephalopathy is a syndrome of neuropsychiatric dysfunction caused by portosystemic venous shunting with or without the presence of intrinsic liver disease. Clinical presentations are variable ranging from an abnormal sleep pattern to somnolence and deep coma. Decerebrate and decorticate posturing, have been rarely reported with hepatic encephalopathy. We report a case of a 59-year-old-man with a history of Child-Pugh B liver disease secondary to chronic alcoholism who was admitted because of coma. He had a transjugular intrahepatic portosystemic shunt 3 months prior to his presentation. He was found to have decerebrating posture. He was treated for hepatic encephalopathy with complete recovery and resolution of the neurologic findings. The physician should be aware that decerebration and decortication posture can occur with hepatic encephalopathy and can be reversible.

Reversible Decerebrate Posture in Hepatic Encephalopathy: Case Report and Literature Review

“…It was noted that the development of coma and posturing was usually rapid from the time of development of altered mental status. Compared to earlier cases [3][4], the recently documented ones ( [5] and ours) have a much shorter hospital stay and rapid recovery suggesting improved hepatic encephalopathy management strategies. Most patients showed quick recovery and the posturing was completely reversed in those that recovered.…”

“…Presentation of hepatic encephalopathy varies widely from mild lack of awareness, lethargy, somnolence, to hepatic coma. Decerebrate posturing, although rare, has been reported in some patients with hepatic encephalopathy [3][4][5]. It is described as an involuntary extension, adduction, and pronation of the upper extremities in response to external stimuli.…”

Hepatic Encephalopathy

“…Patients may open their eyes, but this is not done on command or in conjunction with any purposeful behavior. Decerebrate or decorticate posturing may be seen, even without sternal pressure [ 61 ] and may be a sign of raised ICP. Increased ICP is associated with poor outcome, including high rates of mortality, if not controlled [ 62 ] .…”