Monday, December 16, 2019

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



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.

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