Acute liver failure brain edema

Unfortunately, the development of brain edema can hardly be monitored in patients with acute liver failure. Brain edema mostly occurs when hepatic encephalopathy has progressed to grades III to IV. In grades I-II encephalopathy, it has rarely been observed. With progression to grade III HE cerebral edema occurs in up to 35% and with grade IV HE in 65 to 75% of the patients (Munoz, 1993). 

Rose, C., Michalak, A., Rama Rao, K.V., Quack, G., Kircheis, G., Butterworth, R.F. L-ornithine-L-aspartate lowers plasma and cerebrospinal fluid ammonia and prevents brain edema in rats with acute liver failure. Hepatology 1999 30 636—640... 

In a further study Bhatia et al. (2006) reported an incidence of seizures of 22.5% in a group of 80 pahents with acute liver failure. All pahents had clinical features of brain edema when seizures occurred. Seizures were more frequent in patients with ammonia levels of > 124 pmol/1 (35%) compared to those with ammonia levels below 124 pmoI/1 (8%). In this study seizures were uniformly fatal and did not respond to standard antiepileptic medication. 

Brain Edema the Most Severe Complication of Acute Liver Failure... 

Further, data of Larsen et al. (1995b) show that early in the course of the disease increases in ICP may also be combined with increases in the flow velocity. This finding is in accordance with the cnrrent hypotheses that an increase in CBF is of critical importance for the development of brain edema and infiacranial hypertension in acute liver failure. In the stndy of Larsen et al. an increase of the median... 

Acute fulminant hepatic failure has not been an important condition which has been treated to date with liver transplantation . This apparently paradoxical situation obtains because such patients rapidly deteriorate and consideration of transplantation as a therapeutic option usually is initiated only after advanced coma has occurred. In such case, brain edema leading to herniation usually occurs before an appropriate donor can be identified and transplantation can be accomplished. Moreover, the likelihood of recurrent infection in cases of fulminant viral hepatitis would seem to be great and therefore not warrant the procedure. 

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