A 45-year-old woman presented progressive consciousness compromise 24 hours before admission to the emergency department.
She had a history of drug-induced hepatitis five years before (ibuprofen).
The patient was ic seizure, total bilirubin 26.5 mg/dl, HBV-A-C (-), prothrombin 69%, impaired consciousness.
Fulminant hepatitis of unknown etiology and grade III encephalopathy were diagnosed.
He didn't get surveillance, reactive isochoric pupils, he moved his extremities.
Brain CT with moderate oedema
Two days later prothrombin was 19%, in underlying days 11%.
He is a transplant with encephalopathy grade IV on the sixth day, in electrolyte balance.
The next day he became watchful, threw the threat, reactive myotic pupils, but did not move his extremities, live reflexes, Babinski.
On the third day, he watched, tetraplegia, and hyperrephectic.
Speaking on the fourth day, still confused, he began to move his hands.
On the fifth day, verborrhoea and delirium begin, moving the left hand slightly more than the right hand.
The next day he intensifies his psychotic features, his hands are more powerful, he manages to support his left forearm and sketch foot movements.
Seventh day post-transplantation.
On the twelfth day, the patient maintained proximal quadriparesis, hyperleukemia and Babinski, with no sensory disorder.
Electromyography ruled out peripheral compromise and MRI showed no bridge injury.
Continue to get better and after a month he's recovered.
