Background: Rifaximin, a nonsystemic antibiotic, may be used alone or in combination with lactulose for reducing the risk of overt hepatic encephalopathy (OHE) recurrence in adults. This analysis evaluated rifaximin alone and rifaximin + lactulose (combination) on health-related quality of life (QOL) and caregiver burden in patients with a history of OHE. Methods: In a [...]

Background: Hepatic encephalopathy (HE) is a common neurological complication in patients with cirrhosis. In addition to numerous morbidity-related issues, HE is associated with substantial economic burden. Treatment includes lactulose or rifaximin, a nonsystemic antibiotic that is indicated for reducing the risk of overt HE recurrence in adults. Rifaximin has also been shown to reduce the [...]

Case Presentation: A 75-year-old African-American female with a past medical history of hypothyroidism, hypertension, and Alzheimer’s dementia presented to the emergency room with altered mental status and concern for possible stroke; family also reported new seizure-like activity. Vitals on admission were significant for severe hypertension however, she was afebrile. Physical exam was limited due to [...]

Case Presentation: The patient is a 70 y.o. female with a history of hypertension, bilateral lower extremity deep vein thrombosis (DVT), and peripheral neuropathy, who was brought to the emergency room (ER) by EMS due to the recent onset of altered mental status. Starting a few days ago, her son noted that she was not [...]

Case Presentation: We report a case of a 44 year old female with a history of hepatitis C and alcoholic cirrhosis, abstinent from alcohol for about two years, who presented from a nursing facility with few weeks of confusion and bilateral lower extremity weakness and imbalance. Her family reported that she was oriented, communicative and [...]

Case Presentation: A 51-year-old woman presented with recurrent confusion and altered mental status over the past 6 months. She reported associated hallucinations, altered sleep cycle and hyper-arousal symptoms. She was treated with lactulose and rifaximin for suspected hepatic encephalopathy with no improvement. She denied any other symptoms. Past medical history was significant for cirrhosis secondary [...]

Case Presentation: A hospitalized 71-year-old female became acutely encephalopathic after an esophagogastroduodenoscopy under conscious sedation which was performed to evaluate a chronic esophageal ulcer and other potential causes of dysphagia. Her past medical history was significant for obesity, hypothyroidism, chronic back pain, peripheral neuropathy, colorectal mucinous adenocarcinoma with carcinomatosis and metastases to the lung, chronic [...]

Case Presentation: A 33 year old male with systemic lupus erythematosus (SLE) complicated by recurrent diffuse alveolar hemorrhage (DAH) presented with ataxia, lethargy, cough, and dyspnea. He had been recently exposed to high intensity immunosuppression for his DAH as it was thought to be secondary to SLE. However, it was later diagnosed as herpes simplex [...]

Case Presentation: Hashimoto encephalopathy is a poorly understood and rare complication of Hashimoto thyroiditis. Patients can present with seizures, movement disorders, or cognitive decline that improves with steroid therapy. The disease is a diagnosis of exclusion, but delay in recognition and treatment can lead to increased morbidity and mortality. A twenty-one year old white female [...]

Case Presentation: A 60-year-old female with history of hypertension, rheumatoid arthritis on Adalimumab, and end stage renal disease (ESRD) due to lupus nephritis for which she was recently started on mycophenolate and high dose steroids, presented with 2-3 hour history of sudden onset severe occipital headache, followed by vomiting episodes and complete loss of vision. [...]