UNEXPECTED NEUROLOGICAL ADVERSE-EFFECTS O F PROTON PUMP INHIBITION THERAPY IN A PATIENT WITH CIRRHOSIS OF THE LIVER

A 49-year-old male patient with alcohol-induced cirrhosis of the liver and peptic ulcer disease developed unexpected neurologic symptoms dur ing treatment with a proton pump inhibitor. He was abstinent and had n o evidence of hepatic encephalopathy. His liver disease was Child's st age B. Oral administration of omeprazole was followed by tremor, imbal ance, and confusion. The patient then became comatose. These symptoms resolved upon discontinuation of the drug and recurred on rechallenge. A causal relationship with omeprazole was considered likely. Identica l symptoms developed after administration of lansoprazole. However, in vestigations disclosed a hematoma of the cerebellum with secondary ext ension to the thalamus, casting doubt on a possible causal relationshi p with lansoprazole