Sunday, February 4, 2018

Pupillary reaction through the different stages of hepatic encephalopathy

Q: How the pupillary reaction progresses through the different stages of hepatic encephalopathy?


Answer: 

Close monitoring of pupillary changes is an integral and essential part of the management of hepatic encephalopathy as it signifies the level of increased intracranial pressure. 
  • A normal response = grade I encephalopathy
  • Hyperresponsive = grade II to III encephalopathy
  • Slowly responsive = grade III to IV encephalopathy
  • Fixed and dilated = probable brainstem herniation


References / further read:

1. Shawcross DL, Wendon JA. The neurological manifestations of acute liver failure. Neurochem Int. 2012 Jun;60(7):662-71.

2. Eelco F.M. Wijdicks, M.D., Ph.D. .N Engl J Med 2016; 375:1660-1670

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