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Elevated intracranial pressure and computed tomography of the brain in fulminant hepatocellular failure
Author(s) -
Muñoz Santiago J.,
Robinson Murray,
Northrup Bruce,
Bell Rodney,
Moritz Michael,
Jarrell Bruce,
Martin Paul,
Maddrey Willis C.
Publication year - 1991
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840130202
Subject(s) - medicine , fulminant hepatic failure , fulminant , cerebral edema , intracranial pressure , brain edema , hepatic encephalopathy , computed tomography , intracranial pressure monitoring , encephalopathy , radiology , cardiology , cirrhosis , liver transplantation , transplantation
Cerebral herniation is a leading cause of death in patients with fulminant hepatocellular failure. Classical signs of elevated intracranial pressure are often absent in these patients. A reliable noninvasive method by which the presence of cerebral edema could be determined is much needed. To assess the efficacy of computed tomography of the brain in this setting, we compared the radiographic findings to the intracranial pressure measured by an epidural monitor in patients with fulminant hepatic failure. Unfortunately, a considerable difference existed between the presence of cerebral edema diagnosed by computed tomography of the brain and elevation of the intracranial pressure. Our observations suggest that in patients with fulminant hepatic failure and advanced hepatic encephalopathy, computed tomography of the brain is of little value in detecting cerebral edema. Pressure monitoring is most important to establish the presence and guide the therapy of intracranial hypertension. (HEPATOLOGY 1991;13:209–212).