The pathophysiology of brain edema in acute liver failure.
Brain edema leading to intracranial hypertension is a cause of death in acute liver failure (ALF). The pathogenesis of this unique complication has been investigated in man, in experimental models and in isolated cell systems. From this experience, an integrated view has emerged, pointing at several mechanisms that contribute to cerebral swelling; an osmotic derangement in astrocytes, changes in cellular metabolism as well as alterations of cerebral blood flow. The ability of mild hypothermia to counteract each of these changes in experimental systems has supported the organization of a clinical trial of mild cooling in this disease. Such an advance can be viewed as the clinical translation of 20 years of research in this area.
Blei
Andres T
AT
Division of Hepatology, Department of Medicine, Lakeside VA Medical Center and Northwestern University Feinberg School of Medicine, Tarry Building - Room 14-707, 303 E Chicago Ave, Chicago, IL 60611, USA. a-blei@northwestern.edu
D000818:Animals; D001253:Astrocytes / Q000378:metabolism; D001929:Brain Edema / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D048429:Cell Size; D002560:Cerebrovascular Circulation / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology; D006501:Hepatic Encephalopathy / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D007036:Hypothermia, Induced / Q000639:trends; D017114:Liver Failure, Acute / Q000378:metabolism / Q000503:physiopathology*; D014882:Water-Electrolyte Balance / Q000502:physiology