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Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles

Karin Weissenborn1

  • 1Clinic for Neurology, Hannover Medical School, 30623, Hannover, Germany. weissenborn.karin@mh-hannover.de.

Drugs
|February 2, 2019
PubMed

Insights

Hepatic encephalopathy (HE) is brain dysfunction from liver issues. This review covers type C HE in cirrhosis patients, from subtle changes to coma, using the West Haven criteria for grading severity.

Area of Science:

  • Hepatology
  • Neurology
  • Gastroenterology

Background:

  • Hepatic encephalopathy (HE) is brain dysfunction caused by liver insufficiency or portal-systemic shunting.
  • Type C HE specifically refers to HE in patients with liver cirrhosis.
  • Manifestations range from subclinical neurological/psychiatric changes to coma.

Purpose of the Study:

  • To review hepatic encephalopathy (HE) in liver cirrhosis patients.
  • To discuss diagnostic criteria and grading scales for HE.
  • To highlight challenges in diagnosing HE due to non-specific symptoms.

Main Methods:

  • Review of literature on hepatic encephalopathy in liver cirrhosis.
  • Discussion of diagnostic scales, including the West Haven criteria (WHC).
  • Exploration of minimal hepatic encephalopathy (MHE) and its classification.

Main Results:

  • HE presents a spectrum of neurological and psychiatric abnormalities in cirrhosis.
  • The West Haven criteria (WHC) are commonly used for grading overt HE.
  • Minimal hepatic encephalopathy (MHE) involves brain dysfunction without overt symptoms.

Conclusions:

  • Diagnosis of HE and MHE requires excluding other causes of brain dysfunction.
  • Covert HE (MHE + WHC Grade I) and overt HE (WHC Grades II-IV) are proposed classifications.
  • Non-specific symptoms complicate HE diagnosis, necessitating differential diagnosis.

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