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 concerning and require urgent medical evaluation. In someone with liver cirrhosis (the late stage of permanent scarring (fibrosis) of the liver caused by long-term damage from conditions like hepatitis or chronic alcohol abuse), reduced alertness, confusion, and excessive sleepiness can occur due to hepatic encephalopathy (a reversible, serious neuropsychiatric disorder causing cognitive decline, confusion, and personality changes due to advanced liver dysfunction), especially if lactulose is taken irregularly, allowing toxins like ammonia to accumulate.

However, because he recently had a fall, doctors must also consider head injury or intracranial bleeding. Trauma can worsen mental status in cirrhotic patients, and people with liver disease sometimes have impaired blood clotting, which increases the risk of bleeding inside the brain after even minor trauma.

Both conditions can produce similar symptoms, such as confusion, drowsiness, and poor responsiveness, so doctors differentiate them using clinical examination, blood tests, and brain imaging. They will look for typical signs of hepatic encephalopathy, such as asterixis (a clinical sign characterized by the inability to maintain a sustained posture, resulting in brief, irregular, jerky lapses of muscle tone), high ammonia, or triggers like constipation (a common digestive issue characterized by infrequent bowel movements and stools that are hard, dry, lumpy, and difficult or painful to pass) or infection, while also checking for neurological deficits that might suggest brain injury.

Because your father is barely responsive and keeping his eyes closed, this is potentially serious. He should be taken to the emergency department immediately. In such cases, doctors usually perform an urgent CT (computed tomography) scan of the brain to rule out bleeding or trauma-related injury while also treating possible hepatic encephalopathy with medications like lactulose and supportive care.

Prompt evaluation is essential because both intracranial bleeding and severe hepatic encephalopathy can progress rapidly if untreated.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.