Differential diagnosis

Hepatic encephalopathy (HE) is diagnosed on the basis of the clinical picture, necessary investigations for the differential diagnosis include laboratory tests, psychometric tests, imaging procedures and occasionally electrophysiological examinations.1

Imaging procedures like CT or MRI are indicated to exclude other cerebral processes especially cerebral haemorrhage. If symptoms corresponding to bleeding are present, these imaging techniques are first-line investigations.1

Other conditions which might suggest a differential diagnosis of HE include:1

Other metabolic and toxic encephalopathiesCompressive, intracranial processesPsychiatric disorders
Electrolyte disturbancesCraniocerebral injuriesDepression
Wilson’s diseaseSubdural haematomaSchizophrenia
Wernicke’s encephalopathy  
Alcohol withdrawal syndrome  


1. Zhan T, Stremmel W. The diagnosis and treatment of minimal hepatic encephalopathy. Dtsch Arztebl Int. 2012;109(10):180-7.