Cerebral Edema and Super-Refractory Status Epilepticus After Transjugular Portosystemic Shunt Revision

ABSTRACT We present a rare case of super-refractory status epilepticus directly after transjugular portosystemic shunt placement. Despite aggressive management with multiple antiepileptics, osmotic agents, and continuous veno-venous hemofiltration, the outcome was ultimately fatal. This case underscores the importance of maintaining a high index of suspicion when evaluating altered mental status in patients after recent transjugular portosystemic shunt placement and highlights the need for early diagnostic workup. Electroencephalogram and brain magnetic resonance imaging are valuable tools in distinguishing super-refractory status epilepticus caused by hepatic encephalopathy from other etiologies.