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

• Published in: Neurocritical care Vol. 13; no. 2; pp. 247 - 251
• Main Authors: Hunter, Gary R. W., Young, G. B.
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01.10.2010; Springer Nature B.V
• 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; Prognosis; MRI; Hyperacute hepatic failure; EEG
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-010-9391-9

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.