Cerebral edema during hepatic encephalopathy in fulminant hepatic failure

Thirteen out of 18 patients with fulminant hepatitis developed cerebral edema macroscopically confirmed at autopsy. Cerebral bleeding and herniation were also observed in 38 and 8% of edema cases, respectively. No significant difference was found in the clinical backgrounds (age, sex, laboratory data) of patients with and without cerebral edema. Respiratory distress (100% of edema cases, p less than 0.05), abnormal pupils (89%, p less than 0.10), convulsions (61%) and tachycardia unrelated to fever (60%) were more frequently observed in cerebral edema cases than in those without edema. The frequency of convulsions increased as hepatic encephalopathy progressed, and the frequency of respiratory distress and abnormal pupils in edema cases was significantly higher at the coma grade V of hepatic encephalopathy. Tachycardia was detected early, even at the mild grades of hepatic encephalopathy. These results suggest that symptoms due to cerebral edema such as convulsions, abnormal pupils and respiratory distress should be distinguished from those due to hepatic encephalopathy in fulminant hepatitis patients.