A 62-year-old diabetic woman with annular granulomas was monitored in dermatology.
For one month, the patient had suffered from frequent diarrhea, nausea, choluria, acholia and weight loss.
Hepatic enzymes (GPT 2003, GOT 2670, FA 232, BT 20.2,), prothrombin 27%, HBV-C negative.
Ultrasound showed decreased liver size and cholelithiasis confrmed by abdominal CT, with signs of chronic liver disease.
Sporous, little reactive patient.
Fulminant hepatitis of unknown cause was diagnosed on chronic liver damage.
It continued to be serious, unconscious, responses of dismissal, reactive pupils, present oculocephalic reflexes, abolished osteotendinous reflexes, bilateral Babinski.
Brain CT showed small ventricles and cerebral edema.
ICP captor was installed.
He was transplanted with grade IV hepatic encephalopathy without osmolar alterations.
After 24 hours, she had reactive coma, flaccidity of extremities, areflexia, indifferent plantaris, reactive isochoric pupils.
Third day, eyes open, gaze is not directed, eyelashes to threat, spherical quadriplegia.
Encephalopathic EEG.
On the fifth day he watched, turned his eyes, spherical quadriplegia, Babinski.
On the eighth day prothrombin was 100%.
She was active, fulfilled orders, did not express herself by intubation, easily moved her head and distally her upper limbs, maintained plejia of lower limbs.
Extubated, ninth day, alert, active, conserved language, quadriparetic, without sensory disorder.
The patient was in a catorce normal language, proximal quadriparetic, both hands were fixed and performed preflexure, flexion of the knee and extension of the forearm, did not raise the arms, but lifted the shoulders, and achieved flexion
MRI at day 22 showed protuberance signal changes, visible in T2 and FLAIR sequences.
Diffusion and ADC map showed changes at this level.
EMG defined chronic neuropathy that would explain the coolness.
Being in good condition, sudden hypotension, loss of consciousness and coma occurred that lasted several days, with recurrence of quadriparesis.
The new MRI defined ischemic cortical lesions and protruding cortical lesion.
The patient was discharged one month later, with quadriparesis and cognitive impairment.
