Clinical Stages of Portosystemic Encephalopathy
Stage | Cognition and Behavior | Neuromuscular Function |
|---|---|---|
0 (subclinical) | Asymptomatic loss of cognitive abilities | None |
1 | Sleep disturbances Impaired concentration Depression, anxiety, or irritability | Monotone voice Tremor Poor handwriting Constructional apraxia |
2 | Drowsiness Disorientation Poor short-term memory Disinhibited behavior | Ataxia Dysarthria Asterixis Automatisms (eg, yawning, blinking, sucking) |
3 | Somnolence Confusion Amnesia Anger, paranoia, or other bizarre behavior | Nystagmus Muscular rigidity Hyperreflexia or hyporeflexia |
4 | Coma | Dilated pupils Oculocephalic or oculovestibular reflexes Decerebrate posturing |
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