# Hepatic encephalopathy due to non-cirrhotic portal hypertension associated with non-alcoholic steatohepatitis and chronic hepatitis B: a Case Report

## TL;DR

A patient with liver-related brain dysfunction had overlapping conditions including fatty liver disease, hepatitis B, and high portal pressure, requiring complex diagnosis and treatment.

## Contribution

This case report highlights the diagnostic and therapeutic challenges of hepatic encephalopathy in the context of overlapping non-cirrhotic liver diseases.

## Key findings

- The patient's hepatic encephalopathy was linked to non-cirrhotic portal hypertension, NASH, and HBV.
- Multimodal imaging was essential to differentiate encephalopathy from cirrhosis.
- Treatment required addressing metabolic issues like insulin resistance common in NASH and HBV.

## Abstract

This case report examines the diagnostic and therapeutic complexities presented by a patient with hepatic encephalopathy resulting from overlapping pathologies of non-alcoholic steatohepatitis (NASH), hepatitis B virus (HBV) infection, and non-cirrhotic portal hypertension (NCPH). Highlighting the intricate relationship among these conditions, this study delineates the distinct and overlapping clinical features, diagnostic challenges, and therapeutic approaches. The patient exhibited atypical symptoms typical of NASH but lacked clear signs of cirrhosis, complicating both the diagnostic process and the therapeutic management. The diagnostic journey involved a nuanced assessment using multimodal imaging techniques, which were crucial in distinguishing between hepatic encephalopathy caused by cirrhosis and that due to NCPH. Treatment strategies had to be carefully tailored to address the specific etiological factors and pathology of the conditions involved, with particular attention to managing metabolic disorders such as insulin resistance and abnormalities in lipid and glucose metabolism, frequently observed in both NASH and HBV. The case underscores the need for a comprehensive and individualized approach in managing complex hepatic conditions, especially when conventional diagnostic criteria and treatment protocols face limitations.