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?


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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