[Successful balloon-occluded retrograde transvenous obliteration (B-RTO) in a case of symptomatic epilepsy with hepatic encephalopathy due to non-cirrhotic porto-systemic shunt].

We report a 66-year-old man with hepatic encephalopathy due to a non-cirrhotic porto-systemic shunt during the course of treatment for epilepsy with sodium valproate. The patient developed symptomatic epilepsy after an operation for intracranial arterio-venous malformation at the age of 41, and had been treated with sodium valproate and phenytoin since. At the age of 66, he developed convulsions that were thought to be symptomatic epilepsy with hyperammonemia. Despite sodium valproate having been tapered rapidly and then discontinued, hyperammonemia continued. Abdominal contrast enhanced CT demonstrated a large spleno-renal shunt. Although he was treated with lactulose, he developed encephalopathy with hyperammonemia several times. At the age of 67, we occluded the spleno-renal shunt by balloon-occluded retrograde transvenous obliteration (B-RTO), after which, his clinical symptoms improved, together with normalizing of the ammonia level and EEGs.