What are the signs of encephalopathy in patients with acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
  • Print
Answer

Assess the patient for signs of encephalopathy. See the table below.

Table. Grading of Hepatic Encephalopathy (Open Table in a new window)

Grade

Level of Consciousness

Personality and Intellect

Neurologic Signs

Electroencephalogram (EEG) Abnormalities

0

Normal

Normal

None

None

Subclinical

Normal

Normal

Abnormalities only on psychometric testing

None

1

Day/night sleep reversal, restlessness

Forgetfulness, mild confusion, agitation, irritability

Tremor, apraxia, incoordination, impaired handwriting

Triphasic waves (5 Hz)

2

Lethargy, slowed responses

Disorientation to time, loss of inhibition, inappropriate behavior

Asterixis, dysarthria, ataxia, hypoactive reflexes

Triphasic waves (5 Hz)

3

Somnolence, confusion

Disorientation to place, aggressive behavior

Asterixis, muscular rigidity, Babinski signs, hyperactive reflexes

Triphasic waves (5 Hz)

4

Coma

None

Decerebration

Delta/slow wave activity


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!