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Neurocritical Care

, Volume 13, Issue 2, pp 247–251 | Cite as

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

  • Gary R. W. Hunter
  • G. B. YoungEmail author
Practical Pearl

Abstract

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.

Keywords

Hyperacute hepatic failure EEG MRI Prognosis 

Notes

Conflict of interest statement

Neither author has any financial interest in the content of the paper.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.University of Western Ontario, LHSCLondonCanada
  2. 2.Department of Clinical Neurological SciencesUniversity HospitalLondonCanada

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