GlenRocks

One of my relatives had a massive brainstem stroke in 1999 causing deficits in swallowing, speech, balance and executive functions (mental, judgement, etc). He had a near-miraculous recovery - he was able to walk on his own, drive, talk normally, eat normally - everything came back but some of the mental functioning.

In June, he started developing minor speech problems, abnormal sleep patterns, could no longer walk without a walker, and could no longer manage his medications, no longer could keep track of the days of the week, etc.

Then in July he started having episodes of acute mental confusion where he could no longer talk or walk and his blood pressure was high. He went to the hospital from dialysis in a state of unresponsiveness three times, but in the hospital he would stabilize and come out of it - it took a little longer each time, but he always did. This happened four times in a six week period. First his speech & responsiveness would suddenly return, and then a few days later he'd be close to normal again. I asked for CT scans on every ER visit, and they did them, with nothing abnormal showing up.

ALL of us thought he "obviously" was having another stroke or had already had one, or was having TIAs because another one was on the way. He was admitted to a nursing home because of the danger of falls, his desire to drive, inability to manage his medications, and need for renal/diabetic diet.

Again he was hospitalized after dialysis, and this time a different ER doctor took an interest in the case. This time, I asked them to call in a neurologist to make sure, and he agreed that we needed to. The neurologist ordered two different MRI's - both of which showed nothing abnormal except the old stroke infarct.

Imagine our surprise when his new primary doctor came to see him, did a physical exam, and ordered different blood tests and ultrasound exams -- he then diagnosed a totally new illness: cirrhosis of the liver (brought on by diabetes)! Due to the renal and liver failure, his body can no longer rid itself of ammonia, and it had built up to toxic levels. It's called "hepatic encephalopathy" and the symptoms are nearly identical to his old stroke deficit symptoms.

After two days of huge doses of lactulose (a fast-acting laxative that caused diarrhea), he finally "got it out of his system" and was back to normal - the dementia and confusion were gone. He is now on a daily maintenance dose of lactulose and he hasn't been hospitalized since. The down side is that all of the problems that he developed in June have remained, probably due to brain damage from the ammonia.