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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Hepatic encephalopathy with reversible focal neurologic signs resembling acute stroke: case report.
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Hepatic encephalopathy with reversible focal neurologic signs resembling acute stroke: case report.

机译：伴有类似于急性中风的可逆局灶性神经系统体征的肝性脑病：病例报告。

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A 64-year-old female with a history of primary biliary cirrhosis and esophageal varices starting at age 39 was brought to our Stroke Care Unit by ambulance with right-side weakness and speech difficulty. Physical examination revealed right hemiparesis (including the face), sensory disturbances, pathological reflexes, and slightly decreased consciousness, with a Glasgow Coma Scale rating of E3V4M6. Flapping tremors and speech disturbance, as well as anarithmia, construction apraxia, and ideomotor apraxia, were noted, and her National Institutes of Health Stroke Scale score was 13. Initially, the patient was diagnosed with acute stroke and treated accordingly; however, subsequent findings from clinical images and electroencephalography led to a diagnosis of focal neurologic signs due to hepatic encephalopathy (HE). The patient had significantly reduced cerebral blood flow in the left side of the brain, probably due to microsurgical repair of an aneurysm done 2 years earlier. HE with exaggerated chronic liver damage might have made the previously silent ischemia clinically apparent. This interpretation is supported by the fact that the patient's neurologic deficits resolved once HE was adequately controlled. This case illustrates the need for careful assessment of background pathophysiology when diagnosing patients with stroke-like symptoms.
机译：一名64岁的女性，从39岁开始有原发性胆汁性肝硬化和食管静脉曲张病史，她的救护车因右侧无力和言语困难而被送往我们的中风监护病房。体格检查发现右半身轻瘫（包括面部），感觉障碍，病理反射和意识轻微下降，格拉斯哥昏迷评分等级为E3V4M6。记录了震颤和语言障碍，以及失语症，建筑失用和意识形态运动性失用，她的国立卫生研究院卒中量表评分为13。最初，该患者被诊断为急性中风并接受了相应治疗;然而，随后从临床图像和脑电图上的发现导致诊断为肝性脑病（HE）引起的局灶性神经系统体征。该患者的大脑左侧脑血流量显着减少，可能是由于2年前对动脉瘤进行了显微外科手术修复。具有过度慢性肝损伤的HE可能使先前无症状的缺血在临床上显而易见。一旦适当控制HE，患者的神经功能缺损便得到解决，这一事实得到了支持。该病例说明在诊断患有中风样症状的患者时需要仔细评估背景病理生理学。

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