pupillary responses of hepatic encephalopathy

Q: How the pupillary response differs at different grades of hepatic encephalopathy?

Answer: Cerebral edema correlates with the degree of liver failure causing increased intracranial pressure. Pupillary examination is a good surrogate to determine the level of hepatic encephalopathy besides other clinical signs.

• Grade I - normal response
• Grade II - hyperresponsive
• Grade III - slowly responsive
• Grade IV - fixed and dilated

#physical-exam
#neurology
#hepatology


References:

1. Gill RQ, Sterling RK. Acute liver failure. J Clin Gastroenterol 2001; 33:191.

2. Shawcross DL, Wendon JA. The neurological manifestations of acute liver failure. Neurochem Int. 2012 Jun;60(7):662-71. doi: 10.1016/j.neuint.2011.10.006. Epub 2011 Nov 2.