Which sign indicates hepatic encephalopathy?

• A. Nystagmus
• B. Seizure
• C. Asterixis
• D. Tremor

Answer: (C)

Asterixis is the hallmark sign of hepatic encephalopathy. When liver function falters, toxins like ammonia accumulate and affect brain function, leading to characteristic motor and cognitive changes. Asterixis, a negative myoclonus or flapping tremor of the hands, occurs when the patient extends the arms and dorsiflexes the wrists. The hands suddenly “flap” as the brain can’t maintain sustained muscle contraction, reflecting metabolic brain dysfunction from liver failure.

This sign is more specific to hepatic encephalopathy than the others. Nystagmus can appear in various conditions affecting the nervous system; seizures can occur in severe cases but are not the typical early or defining sign; tremor by itself is non-specific and may be due to many causes. So the presence of asterixis directly points to metabolic encephalopathy related to liver disease.