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Neurological signs of HE are mainly consistent with forebrain involvement and include alterations in behaviour or personality, obtundation that may progress to stupor and coma, continuous pacing, aimless wandering, circling, head pressing, hypersalivation (particularly in cats), blindness and seizures. The neurological signs are often intermittent. Several factors can precipitate or exacerbate neurologic signs of HE (Box 4.3).

Non-neurological signs of HE vary depending on the underlying hepatic disease and include polyuria-polydipsia, vomiting, diarrhoea, weight loss, decreased endurance, ascites, icterus (rarely) and, in case of congenital portosystemic shunt, retarded or insufficient growth and signs of lower urinary tract disease (stranguria, pollakiuria, hematuria, dysuria) due to ammonium biurate crystalluria. Copper-coloured irises unusual for the breed have been reported in cats with congenital portosystemic shunts (Plate 1).