Grover, VPVPGroverTognarelli, JMJMTognarelliMassie, NNMassieCrossey, MMMMCrosseyCook, NANACookTaylor-Robinson, SDSDTaylor-Robinson2016-01-122015-12-162016-01-122015-12-16International Journal of General Medicine, 2015, 8, pp.381-3901178-7074http://hdl.handle.net/10044/1/28669Hepatic encephalopathy is a common neuropsychiatric abnormality, which complicates the course of patients with liver disease. It was probably first described by Hippocrates over 2000 years ago, who said that "those whose madness arises from phlegm are quiet and neither shout nor make a disturbance, while those whose madness arises from bile shout, play tricks and will not keep still, but are always up to some mischief ". He was presumably describing the differences between patients with pneumonia and acute liver failure. Despite the fact that the syndrome was probably first recognized thousands of years ago, the exact pathogenesis still remains unclear. Furthermore, a precise definition of the syndrome is lacking, as are definitive methods of diagnosing this condition. It is important as both patients with cirrhosis and the general population with whom they interact may be affected as a consequence. At a minimum, the individual may be affected by impaired quality of life, impaired ability to work, and slowed reaction times, which are relevant to the population at large if affected individuals operate heavy machinery or drive a car. Pathogenic mechanisms, diagnostic tools, and treatment options are discussed.© 2015 Grover et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpammoniacirrhosishepatic encephalopathylactulosepathologyrifaximintreatmentJournal Articlehttps://www.dx.doi.org/10.2147/IJGM.S86854PC2929 01/06/2002None givenDMAGA_P048375R01AA020203-02RDA01 79560N/A1178-7074