[Therapy-refractory hepatic encephalopathy or acquired hepato-cerebral degeneration - a challenging differential diagnosis].

Hepatic encephalopathy is a common complication of liver cirrhosis, which is normally successfully treated with lactulose and rifaximin as well as control of the initial trigger In most cases, cognitive symptoms such as confusion and disorientation regress with this treatment. However, if the hepatic encephalopathy is refractory to treatment, further differential diagnoses should be considered. Acquired hepatocerebral degeneration is a rarely diagnosed entity in patients with liver cirrhosis. Typically, patients have extrapyramidal motor symptoms in addition to cognitive dysfunction. We report on a 58-year-old patient with recurrent refractory encephalopathic episodes who was finally diagnosed with acquired hepatocerebral degeneration.