Recovery of Awareness after Hyperacute Hepatic Encephalopathy with “Flat” EEG, Severe Brain Edema and Deep Coma

Background Hyperacute hepatic failure (HHF) has a high mortality rate that is most commonly due to severe cerebral edema. However, brain swelling and marked clinical and EEG suppression are potentially reversible, even though the same findings are associated with a very poor neurological outcome in...

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Bibliographic Details
Published in:Neurocritical care 2010-10, Vol.13 (2), p.247-251
Main Authors: Hunter, Gary R. W., Young, G. B.
Format: Article
Language:English
Subjects:
Acetaminophen - toxicity
Adult
Ammonia
Analgesics
Awareness - physiology
Benzodiazepines
Brain Edema - physiopathology
Critical Care Medicine
Cytotoxicity
Edema
Electroencephalography - methods
Hepatic Encephalopathy - physiopathology
Hepatitis
Hepatitis, Viral, Human - complications
Humans
Hypothermia
Hypoxia-Ischemia, Brain - physiopathology
Intensive
Internal Medicine
Ischemia
Liver
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Male
Medical imaging
Medicine
Medicine & Public Health
Mortality
Neuroimaging
Neurology
Practical Pearl
Sepsis
Toxicity
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Summary:Background Hyperacute hepatic failure (HHF) has a high mortality rate that is most commonly due to severe cerebral edema. However, brain swelling and marked clinical and EEG suppression are potentially reversible, even though the same findings are associated with a very poor neurological outcome in anoxic-ischemic encephalopathy. Methods We present three cases that illustrate neurological recovery despite severe brain swelling and loss of EEG activity. Results All patients recovered conscious awareness, including one who transiently lost cranial nerve reflexes. Conclusions Despite deep coma, markedly suppressed EEG and brain edema, aggressive control of ICP may lead to good recovery in acute hepatic failure.
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-010-9391-9