As may hepatic encephalopathy and the genetic disorder porphyria. It was then recognized as a transmissible spongiform encephalopathy in 1978. Hepatic encephalopathy is possibly reversible with treatment. Lactulose is therefore effective in treating hepatic encephalopathy. The diagnosis of minimal hepatic encephalopathy requires neuropsychological testing by definition. The increase in metabolites may cause encephalopathy or cerebral edema. Specifically, it is effective as secondary prevention of hepatic encephalopathy in people with cirrhosis. The antibiotics neomycin and metronidazole are other antibiotics used to treat hepatic encephalopathy. Lactulose is useful in treating high blood ammonia, which can lead to hepatic encephalopathy. In the acute setting, this may be a cause of hepatic encephalopathy and hepatorenal syndrome. Encephalopathy or delirium may develop relatively slowly and resemble dementia. This can lead to confusion or even coma (hepatic encephalopathy). Diagnosis of Wernicke encephalopathy or disease is made clinically. The impairment of cerebral blood flow that underlies hypertensive encephalopathy is still controversial. Lactulose is a non-absorbable sugar used in the treatment of constipation and hepatic encephalopathy.