Symptoms:

• Agitation
• Changes in mental state, consciousness, behavior, personality
  • Changes in mood
  • Coma
  • Confusion, disorientation
  • Decreased alertness, daytime sleepiness
  • Decreased responsiveness
  • Delirium
  • Dementia
  • Forgetfulness
• Deterioration of handwriting or loss of other small hand movements
• Dysfunctional movement
• Muscle stiffness
• Muscle tremors
• Seizures (rare)
• Speech impairment
• Uncontrollable movement

Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.

Signs and tests:

Nervous system signs may change. Signs include:

• Coarse, "flapping" shaking of the hands when attempting to hold the arms out in front of the body and lift the hands
• Abnormal mental status, particularly cognitive (thinking) tasks such as connecting numbers with lines
• Signs of liver disease, such as yellow skin and eyes (jaundice) and fluid collection in the abdomen (ascites), and occasionally a musty odor to the breath and urine

Tests may include:

• Blood chemistry
• CT scan of the head or MRI
• EEG
• Prothrombin time
• Serum ammonia levels