RESEARCH Open Access Role of minimal hepatic encephalopathy in road traffic accidents Mohammad Mohai El-Din Awad 1 ˆ , Abd-El Raouf Mohamed El-Deib 1 , Fadia Mostafa Attia 2 , Mohamed Negm 3* , Mohamed Hassan Mohamed Soliman 1 and Wafaa Hassan Omar 4 Abstract Background: The term minimal hepatic encephalopathy (MHE) is defined as encephalopathy that does not lead to clinically overt cognitive dysfunction but can have an impact on quality of life, risk of involvement in road traffic accidents, and ability to function in daily life. Objective: To identify the incidence of minimal hepatic encephalopathy in patients actively involved in a road traffic accident and its role in the increased incidence of road traffic accidents. Patients and methods: We included 74 patients presented in road traffic accidents (drivers, history of fall, pedestrians whom accidents occur during crossing the road) with clinically proven hepatic cirrhosis, without clinical manifestation of hepatic encephalopathy (HE). Thorough history taking, clinical examinations, routine laboratory investigations, serum IL-6 and ammonia in blood were done. Diagnosis of MHE is based on psychometric hepatic encephalopathy score (PHES) which includes digit symbol test (DST), number connection test-A (NCT-A), number connection test-B (NCT-B), serial dotting test (SDT), and line drawing test (LDT). Results: The mean age was 52.0 ± 7.47 in MHE patients. Most of the MHE patients were males. Most of the patients with MHE were working other jobs and were not drivers (63.2% vs 36.8%). MHE was observed in 19 patients (25.7%). Albumin, interleukin-6 (IL-6), and ammonia were statistically significantly different between both groups. Conclusion: Minimal hepatic encephalopathy (MHE) was observed in 25.7% of patients which points that we must give attention in the screening of MHE as road traffic accident is considered the main cause of mortality in our community with high incidence of liver disease. Keywords: Minimal hepatic encephalopathy, Road traffic accidents, Egypt Introduction Hepatic encephalopathy (HE) is a manifestation of neuropsychiatric symptoms (after exclusion of another brain disease) in patients with liver cirrhosis. It is char- acterized by personality changes, cognitive dysfunction, and altered level of consciousness [1]. The term minimal hepatic encephalopathy (MHE) is the encephalopathy that does not associate with clinic- ally overt cognitive dysfunction but can be diagnosed by neuropsychological tests [2]. Patients with MHE have no known clinical criteria of HE but have only mild psycho- motor and cognitive impairment. Minimal hepatic encephalopathy (MHE) may have a bad impact on qual- ity of life, risk of road traffic accidents, and difficulties in daily life and can be converted to overt HE [3, 4]. Navigation is a collection of processes needed for driv- ing safely and requires that working memory, attention, and speed of mental processing are intact. Navigation difficulty can be found in patients with cirrhosis and MHE which is characterized by poor attention and re- sponse inhibition [5]. Minimal hepatic encephalopathy (MHE) can be coupled with poor driving skills and a higher risk of motor car ac- cidents due to poor attention and lack of visuomotor co- ordination [6, 7]. Poor psychometric performance is associated with driving difficulties [8]. Standard neurological examination is not enough to diag- nose subtle cognitive function deficit, so the psychometric * Correspondence: Mohnegm2@yahoo.com ˆ Deceased 3 Faculty of Medicine, Suez Canal University, Ismailia, Egypt Full list of author information is available at the end of the article The Egyptian Journal of Neurology, Psychiatry and Neurosurgery © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Awad et al. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery (2019) 55:8 https://doi.org/10.1186/s41983-019-0055-1