Symptoms may include:

• tremor (shaking of arms, head)
• ataxia (unsteady walking)
• difficulty walking
• chorea (uncontrolled body movements)
• myoclonus (spasm of muscles)
• asterixis
• impairment of intellectual function
• coma
• jaundice
• rigidity
• gastrointestinal bleeding from esophageal varices
• ascites (fluid in the abdomen, causing swelling)

A thorough neurological examination may reveal signs of dementia, involuntary movements, and gait instability. Other physical signs of liver disease such as ascites (distended abdomen filled with fluid) and jaundice (yellow color to the skin and whites of eyes) may be evident. Laboratory studies may show an elevated ammonia level and abnormal liver function tests.

Imaging studies of the head may not show any abnormalities or may show non-specific changes in the basal ganglia. An EEG test may show diffuse slowing consistent with an abnormal metabolic process. Diagnosis is based on these neurological findings in seen in the setting of known liver impairment.