Recruitment case 11/15/19 involved an older patient with multiple cardiovascular risk factors / metabolic syndrome presenting with acute onset encephalopathy. Exam was consistent with toxic-metabolic encephalopathy and after stroke was ruled out, they were diagnosed with hepatic encephalopathy secondary to newly diagnosed cirrhosis which was attributed to non-alcoholic steatohepatitis (NASH). They were treated with lactulose and mental status improved. More information here: cirrhosis – 11.15

Take home points:

  • Acute confusional state and weakness are common chief complaints – schema for these will help you evaluate the broad differential and hopefully figure out the cause

  • UNCOMMON presentations of COMMON diseases are more common than….

  • NAFLD is very common with a small subset of patients progressing to cirrhosis

  • Diet, exercise, and weight loss are the treatments of choice for NAFLD/NASH