Is my father’s sleepiness after a fall due to brain injury?

Question

Hello doctor,

My father, aged 55, recently had a minor fall, and after that, he seems more disoriented and sleepy than usual. He has alcoholic cirrhosis and takes lactulose irregularly. Now he barely responds and keeps his eyes closed most of the day.

Could trauma trigger overt hepatic encephalopathy, or should we suspect brain injury also?
How do doctors differentiate between the two conditions?
Should a CT scan be done urgently?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Your father's symptoms are alarming and call for immediate attention. For a person suffering from liver cirrhosis (late phase of fibrosis or hardening of the liver because of damage that results from prolonged infections such as hepatitis or alcoholism), lack of alertness, confusion, and oversleeping may be a result of hepatic encephalopathy (severe neuropsychiatric syndrome which causes deterioration of mental capacity, confusion, and changes in behavior due to poor functioning of the liver). This is especially true when taking lactulose is not consistent.

However, since he has had an incident where he fell down, the possibility of head injury and intracranial bleeding should be considered as well. Traumatic events can make the patient's mental status worse, and some people who suffer from liver disease have coagulation problems, which increase the risk of bleeding in the brain even if there is minor trauma. Both disorders can be associated with similar symptoms such as disorientation, decreased alertness, and decreased response; thus, physicians rely on physical examination, laboratory studies, and imaging to distinguish between them.

Physicians would search for certain features of hepatic encephalopathy like asterixis (one of the clinical signs associated with loss of sustained posture with abrupt lapses of muscle tone), high levels of ammonia, or factors like constipation (a common gastrointestinal condition associated with infrequent bowel movements with hard and dry stool) or infections, while looking for neurological abnormalities as well.

I hope this answers your query.

Thank you.