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Lethargy and coma
In severe hepatic encephalopathy cases, patients do not longer respond appropriately to stimuli, and they move slowly, adopting a sluggish and unintelligible speech. Coma only happens in the fourth stage of hepatic encephalopathy. It is a severe decline of brain function in which the patient no longer responds to any stimuli. They become unresponsive and only wake up from this state when the equilibrium is recovered. This can also result from fulminant hepatic failure, massive necrosis of the hepatocellular tissue. In most cases, 8 weeks after the onset of acute or fulminant hepatic failure, the patient slips into a coma when the problem is not corrected.
