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What is encephalopathy?

Encephalopathy is a general term for disease affecting the brain. Encephalopathy has a variety of causes, but this page will cover one type: hepatic encephalopathy.

What causes hepatic encephalopathy?

Normally, a healthy liver filters and breaks down toxic substances in the blood. When normal liver functions are impaired by infection, alcohol, medication, or other factors, these toxic substances build up and can damage many organs, including the brain. This can cause hepatic encephalophathy.

Hepatic encephalopathy is classified using the West Haven Criteria, which has 4 grades ranging from shorter attention span, personality changes, confusion, and coma.

Risk Factors

Liver disease and other factors that affect liver function can be hepatic encephalopathy causes:

  • Cirrhosis (liver scarring)
  • Alcohol intoxication
  • Infections
  • Sedatives
  • Surgery
  • Complications from transjugular intrahepatic portosystemic shunt (TIPS) placement
  • Dehydration
  • Electrolyte imbalances
  • Low oxygen levels
  • Eating too much protein
  • Bleeding from the esophagus, stomach, or intestines
  • Kidney failure


Hepatic encephalopathy can begin with mild or severe symptoms, ultimately leading to coma if untreated.

Signs of liver disease

  • Musty or sweet-smelling breath
  • Jaundice (yellowing of skin or eyes)
  • Ascites


  • Short attention span
  • Forgetfulness
  • Personality changes
  • Irritability
  • Sleeping during the day and being awake at night
  • Difficulty with fine motor control


  • Confusion
  • Disorientation
  • Severe behavioral changes
  • Asterixis, or involuntary flapping of the hands when arms are extended
  • Lethargy
  • Sluggish movement
  • Slurred speech
  • Seizures


In addition to the symptoms and medical history, tests that may be performed to detect encephalopathy include:

  • Liver function tests
  • Ultrasound of liver
  • CT scan or MRI of brain
  • Electroencephalograph (EEG)
  • Complete blood count (CBC)
  • Electrolyte levels
  • BUN and creatinine levels
  • Ammonia levels


  • Portosystemic shunt embolization

For More Information:

For more information or to schedule an appointment with one of our IR physicians, please call 310-481-7545.