• changes in mental state, consciousness, behavior, personality
  • forgetfulness
  • confusion, disorientation
  • delirium (acute, severe confusion with fluctuating level of consciousness)
  • dementia (loss of memory, intellect, reasoning, and other functions)
  • changes in mood
  • decreased alertness, daytime sleepiness
  • decreased responsiveness, progressive stupor
  • coma
• decreased self-care ability
• deterioration of handwriting or loss of other small hand movements
• coarse muscletremors
• muscle stiffness or rigidity
• seizures (rare)
• speech impairment
• movement, uncontrollable
• movement, dysfunctional
• agitation

Neurologic symptoms may fluctuate. Coarse, "flapping" muscletremor may be observed during voluntary movement, such as when the person attempts to hold the arms out in front of the body (also exhibited as a positive Babinski's reflex).

Mental status examination will be abnormal, particularly cognitive 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 commonly 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 (electroencephalogram, a reading of electrical activity in the brain) shows characteristic abnormalities.