A 36-year-old woman complained of diarrhea and weight loss for six months.
Two patients had associated hyperbilirubinemia of 2.48, prothrombin 28%, transaminase over 2000, abdominal ultrasound showed fatty liver and gallstones, and B-HAV negative.
Antimitochondral and smooth muscle antibodies were negative.
ANA (+) 1/320.
Brain CT was normal.
Grade II/III encephalopathy is hemodynamically stable without renal failure, bilirubin 20.5 mg/dl. It mobilizes without sensory disorders preserved language, extremities, living reflexes, plantar flexions.
Three days later, the patient coma was minimally reactive, with no central motor deficit.
Subacute liver failure secondary to fulminant hepatitis.
In grade IV encephalopathy liver transplantation was performed without electrolyte disturbances.
The next day, the patient became ill, became vigilant and had osteotendinous reflexes.
On the fifth day of consciousness, proximal predominant quadriparesis was able to hold hands and fingers with decreased muscle power, unable to fecate or raise the arms, moving fingers of the feet.
Generalised hyperreflexia.
On the seventh day of consciousness was compromised, Babinski's hyperrefective quadriplegic.
slow EEG.
MRI showed hypointensity on T1 in the motor region of the bridge and hyperintensity on T2, designing bat wings.
From the fifteenth day onwards, watch, do not direct your eyes, quadriplegic.
It remains in a persistent vegetative state.
