Symptoms:

• Changes in mental state, consciousness, behavior, personality
  • Forgetfulness
  • Confusion, disorientation
  • Delirium
  • Dementia
  • Changes in mood
  • Decreased alertness, daytime sleepiness
  • Decreased responsiveness
  • Coma
• Decreased self-care ability
• Deterioration of handwriting or loss of other small hand movements
• Muscle tremors
• Muscle stiffness
• Seizures (rare)
• Speech impairment
• Uncontrollable movement
• Dysfunctional movement
• Agitation

Signs and tests:

Neurological symptoms may change. Coarse, "flapping" muscle tremor may be observed during voluntary movement, such as when the person attempts to hold the arms out in front of the body .

Mental status examination will be abnormal, particularly cognitive (thinking) tasks such as connecting numbers with lines.

Liver disease may be known or may be suspected, and signs of liver disease such as jaundice (yellow skin and eyes) and ascites (fluid collection in the abdomen) may be noted. Occasionally, there is a characteristic musty odor to the breath and the urine.

Blood tests may be nonspecific, or may show liver failure.

• Blood chemistry may show low albumin, high bilirubin, or other abnormalities.
• Serum ammonia levels are usually high.
• Prothrombin time may be prolonged and not correctable with Vitamin K.
• CT scan of the head may be normal, or may show general atrophy (loss of tissue).
• EEG (a reading of electrical activity in the brain) shows abnormalities.