Recovery despite impaired cerebral perfusion in fulminant hepatic failure.
We report 4 patients with fulminant hepatic failure who developed prolonged intracranial hypertension (> 35 mm Hg for 24-38 h) that was refractory to standard therapy and associated with impaired cerebral perfusion pressure (< 50 mm Hg for 2-72 h). All survived with complete neurological recovery. Refractory elevation of intracranial pressure and reduced cerebral perfusion pressure are generally thought to contra-indicate liver transplantation in hepatic failure and are indications to withdraw support. Our observations challenge this concept.
Davies
M H
MH
Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Mutimer
D
D
Lowes
J
J
Elias
E
E
Neuberger
J
J
D000328:Adult; D001921:Brain / Q000098:blood supply*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007427:Intracranial Pressure; D008297:Male