title: Brain edema in acute liver failure. A window to the pathogenesis of hepatic encephalopathy.
abstract: Hepatic encephalopathy and brain edema are important complications in the course of a patient with acute liver failure. Presumed unrelated for many years, increasing evidence suggests that an increase in brain water is seen in all forms of hepatic encephalopathy. Ammonia, traditionally linked to the pathogenesis of hepatic encephalopathy, plays an important role in the increase in brain water. In acute liver failure, an osmotic disturbance in the astrocyte, in combination with an alteration of cerebral blood flow results in overt brain edema and intracranial hypertension. In cirrhosis, magnetic resonance techniques indicate the presence of a brain osmotic disturbance. Several clinical factors modulate the development of brain swelling.
authors.affiliation: Section of Hepatology, Department of Medicine, Lakeside VAMC and Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Vaquero
authors.forename: Chuhan
authors.initials: C
authors.lastname: Chung
authors.forename: Andres T
authors.initials: AT
authors.lastname: Blei
mesh_terms: D000641:Ammonia / Q000378:metabolism*; D001253:Astrocytes / Q000378:metabolism; D001812:Blood-Brain Barrier / Q000502:physiology; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology; D017114:Liver Failure, Acute / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000641:Ammonia