What Are the Symptoms of HE?

HE encompasses a range of symptoms depending on the severity of the condition, so symptoms can vary widely from one person to another. Symptoms may begin slowly and gradually get worse, or they may occur suddenly and be severe from the start.

Mild to moderate symptoms of HE may include the following mental and physical changes:

  • Mental
    • Mild confusion
    • Short attention span
    • Forgetfulness
    • Mood swings
    • Personality changes
    • Inappropriate behavior
    • Difficulty doing basic math
  • Physical
    • Change in sleep patterns (like sleeping during the day and staying up at night)
    • Difficulty writing or doing other small hand movements
    • Breath that smells musty or sweet
    • Slurred speech

More severe symptoms of HE may include these mental and physical changes:

  • Mental
    • Marked confusion
    • Severe anxiety or fearfulness
    • Disorientation regarding time and place
    • Inability to perform mental tasks such as doing basic math
  • Physical
    • Extreme sleepiness
    • Slowed or sluggish movement
    • Shaking of hands or arms (called “flapping”)
    • Jumbled, slurred speech that can’t be understood

In the most severe form of HE, people can become unresponsive, unconscious and enter a coma.