The clinical course of hepatic encephalopathy is generally categorized into five phases according to the degree of impaired consciousness, neurological manifestations and electroencephalographic (EEG) changes: latent phase, prodromal phase, pre-comatose phase, somnolent phase and comatose phase.
Stage 1.0: also known as the “latent stage”. There are no behavioral or personality abnormalities, no neurological signs (e.g., Babinski’s sign, etc.), and the EEG is normal, with only minor abnormalities on psychological or intelligence tests.
Stage 2.1: Also known as the “prodromal stage”. Mild personality changes and mental abnormalities, such as anxiety, euphoria, apathy, sleep reversal, amnesia, etc. Fluttering tremor (involuntary tremor when arms are stretched forward) may be present. The electroencephalogram is mostly normal. The clinical manifestations of this stage are not obvious and easily overlooked.
3.2 Stage 2: also known as “pre-coma”. Drowsiness, abnormal behavior (such as urinating and defecating), slurred speech, dysgraphia and disorientation. There are neurological signs such as hyperreflexia, increased muscle tone, ankle clonus and positive Babinski’s sign, fluttering tremor, and characteristic abnormalities in EEG.
Stage 4.3: also known as “lethargic stage”. It is characterized by lethargy, but can be awakened, and can respond when waking up, often with confusion or hallucinations, various neurological signs persisting or aggravated, fluttering tremor, high muscle tone, hyperreflexia, and neuropathological signs are often positive. There are abnormal waveforms in the EEG.
5.4 Stage 4: also known as “coma stage”. The patient is comatose and cannot be awakened. The patient is unable to cooperate to elicit a fluttering tremor. Tendon reflexes are hyper or absent, and muscle tone is hyper or decreased. The EEG is markedly abnormal.
When hepatic encephalopathy is present, it is necessary to actively consult the doctor and follow the doctor’s instructions for rational treatment.