Hyperammonemic Encephalopathy Caused by Infection in a Neurogenic Bladder

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Abstract
THE contribution of ammonia to the pathogenesis of hepatic encephalopathy has been widely investigated.1 , 2 Hyperammonemia and cerebral dysfunction in the absence of liver disease and portal hypertension have been reported in patients with acquired3 or congenital4 , 5 deficiency of hepatic enzymes of the Krebs urea cycle and in patients who have had ureterosigmoidostomy.6 7 8 9 However, in the latter group coexistent liver disease was present and could have contributed to encephalopathy.6 7 8 9 We report the case of a patient who had recurrent hyperammonemic encephalopathy despite adequate urea-cycle enzymes and normal liver structure. The source of the elevated blood ammonia was excessive bacterial production of . . .