The brain in acute liver failure. A tortuous path from hyperammonemia to cerebral edema

  • Peter Nissen Bjerring
  • Martin Eefsen
  • Bent Adel Hansen
  • Fin Stolze Larsen
Original Paper


Acute liver failure (ALF) is a condition with an unfavourable prognosis. Multiorgan failure and circulatory collapse are frequent causes of death, but cerebral edema and intracranial hypertension (ICH) are also common complications with a high risk of fatal outcome. The underlying pathogenesis has been extensively studied and although the development of cerebral edema and ICH is of a complex and multifactorial nature, it is well established that ammonia plays a pivotal role. This review will focus on the effects of hyperammonemia on neurotransmission, mitochondrial function, oxidative stress, inflammation and regulation of cerebral blood flow. Finally, potential therapeutic targets and future perspectives are briefly discussed.


Acute liver failure Cerebral edema Hyperammonemia Intracranial hypertension 


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Peter Nissen Bjerring
    • 1
  • Martin Eefsen
    • 1
  • Bent Adel Hansen
    • 1
  • Fin Stolze Larsen
    • 1
  1. 1.Dept. Hepatology, section A-2121, RigshospitaletUniversity Hospital of CopenhagenCopenhagenDenmark

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