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KMID : 1100220030020020154
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Dementia and Neurocognitive Disorders
2003 Volume.2 No. 2 p.154 ~ p.158
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A Case of Hepatic Encephalopathy Presenting with Transient Cortical Blindness and Cognitive Impairment
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Yoon Go-Un
Park Min-Jung
Park Kyung-Won
Cha Jae-Kwan
Kim Jae-Woo
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Abstract
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A 55-year-old woman presented with transient cortical blindness and multiple cognitive impairments as initial symptoms of hepatic encephalopathy. Her past history was negative for chronic liver disease or gastrointestinal bleeding. Neurologic examinations showed bilateral visual loss with a normal pupillary reflex to light and neuropsychological tests showed significant impairments in all cognitive domains. Laboratory tests revealed increased liver enzymes, ammonia level, and positive IgG HbcAb. Ultrsonography of the liver showed findings consistent with liver cirrhosis with splenomegaly. The visual evoked potential study resulted in no wave formation on both sides. T1-weighted brain MRI showed high signal intensity lesions in both globus pallidus and cerebral peduncles of the midbrain. After treatment with lactulose, cortical blindness and cognitive dysfunctions disappeared within several days. In rare cases of hepatic encephalopathy, cortical blindness with cognitive impairments may occur before alteration of consciousness and usually recovers following treatment of the hepatic encephalopathy.
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KEYWORD
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Hepatic encephalopathy, Cortical blindness, Cognitive Impairment
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