Clinical and Radiologic Features of Cerebral Edema in Fulminant Hepatic Failure

Eelco F.M. Wijdicks, David J. Plevak, Jorge Rakela, Russell H. Wiesner

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


To describe a series of consecutive patients with fulminant hepatic failure (FHF) and to present a new classification system for brain edema, an important cause of mortality in such patients. We reviewed 22 computed tomographic (CT) scans of the brain in 12 patients with FHF and classified the severity of cerebral edema by using predefined criteria. No cerebral edema was detected on CT scans in four patients with stage 1 or 2 hepatic encephalopathy at the time of admission, but it was noted in seven of eight patients with stage 3 or 4 hepatic encephalopathy. The severity of brain edema on CT scans was significantly correlated (P<0.001) with the stage of hepatic encephalopathy. Three of the four patients who had stage 1 or 2 hepatic encephalopathy at the time of initial assessment ultimately had a good outcome. Of seven patients with stage 3 encephalopathy, two had rapid deterioration to brain death, three died of nonneurologic causes, and two had a good outcome after liver transplantation. One patient with stage 4 hepatic encephalopathy died, and autopsy showed cerebral edema. Stage 3 or 4 hepatic encephalopathy is associated with cerebral edema that can be detected on CT scans. The clinical and radiologic signs of cerebral edema in patients who have progression to stage 3 hepatic encephalopathy can be reversed with conventional treatment of increased intracranial pressure. Whether early recognition and treatment of cerebral edema result in increased survival of patients with FHF remains to be determined.

Original languageEnglish (US)
Pages (from-to)119-124
Number of pages6
JournalMayo Clinic proceedings
Issue number2
StatePublished - 1995


  • BESS
  • CT
  • FHF
  • ICP
  • brain edema severity score
  • computed tomographic
  • fulminant hepatic failure
  • intracranial pressure

ASJC Scopus subject areas

  • Medicine(all)


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