title: Recovery despite impaired cerebral perfusion in fulminant hepatic failure.
abstract: 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.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Davies
authors.forename: D
authors.initials: D
authors.lastname: Mutimer
authors.forename: J
authors.initials: J
authors.lastname: Lowes
authors.forename: E
authors.initials: E
authors.lastname: Elias
authors.forename: J
authors.initials: J
authors.lastname: Neuberger
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007427:Intracranial Pressure; D008297:Male