Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2831-2837
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2831
Propofol pump controls nonconvulsive status epilepticus in a hepatic encephalopathy patient: A case report
Shao Hor, Chih-Yu Chen, Sheng-Ta Tsai
Shao Hor, Department of Anesthesiology, China Medical University Hospital, Taichung 40447, Taiwan
Chih-Yu Chen, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan
Sheng-Ta Tsai, Department of Neurology, China Medical University Hospital, Taichung 40447, Taiwan
Author contributions: Hor S contributed to study conception, data collection, and manuscript writing; Chen CY is the chief doctor of the patient and decided the diagnosis and treatment goal; Tsai ST performed the continuous EEG, made the diagnosis, and initiated this case report.
Informed consent statement: We obtained written inform consent in Chinese from the patient’s wife because the patient was initially in a coma and then confusion in following days.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sheng-Ta Tsai, MD, Attending Doctor, Doctor, Department of Neurology, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40447, Taiwan. d27056@mail.cmuh.org.tw
Telephone: +886-9-28262460 Fax: +886-4-22052121
Received: March 17, 2019
Peer-review started: March 18, 2019
First decision: August 1, 2019
Revised: August 13, 2019
Accepted: August 25, 2019
Article in press: August 26, 2019
Published online: September 26, 2019
Processing time: 192 Days and 20.1 Hours
Abstract
BACKGROUND

Status epilepticus is an emergent and critical condition which needs management without hesitation. Nonconvulsive status epilepticus (NCSE) tends to be less recognized, and its diagnosis is delayed in comparison with overt status epilepticus because of the absence of specific clinical signs. It is often difficult to make a diagnosis, particularly in patients with hepatic encephalopathy.

CASE SUMMARY

A 38-year-old man with a history of alcoholic liver cirrhosis presented with altered mental status; the initial diagnosis was hepatic encephalopathy. Although optimal treatment for hepatic encephalopathy was administered, the patient's mental status did not improve. A final diagnosis of NCSE was made by continuous electroencephalogram (EEG) monitoring. Treatment with levetiracetam and propofol pump was immediately started. The patient’s consciousness gradually improved after discontinuation of propofol therapy, and no further epileptic discharge was observed by EEG monitoring. After 1 wk, the patient returned to full consciousness, and he was able to walk in the hospital ward without assistance. He was discharged with minimal sequela of bilateral conjunctivitis.

CONCLUSION

In cases of persistent altered mental status without reasonable diagnosis, NCSE should be considered in hepatic encephalopathy patients with persistently altered levels of consciousness, and EEG monitoring is very important. We also recommend propofol as a safe and efficient therapy for NCSE in liver cirrhosis patients.

Keywords: Nonconvulsive status epilepticus; Hepatic encephalopathy; Electroencephalogram; Propofol; Multidisciplinary team; Case report

Core tip: This case highlights the probability of nonconvulsive status epilepticus in patients with liver cirrhosis who do not respond to standard treatment. A multidisciplinary team that includes a neurologist, intensivists, and electroencephalography technicians would contribute to achieving a general improvement in patients with this condition. We also recommend that propofol is a reasonable choice of treatment in such cases.