ELEVATION OF INTRACRANIAL-PRESSURE FOLLOWING TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT FOR VARICEAL HEMORRHAGE

Increased intracranial pressure and cerebral oedema in patients with c hronic liver disease is rare and is more typical of acute liver failur e, Transjugular intrahepatic portosystemic stent-shunt is being increa singly used in the management of uncontrolled variceal haemorrhage in patients with cirrhosis, In our institution, a total of 160 patients h as undergone transjugular intrahepatic porto-systemic stent-shunt for variceal haemorrhage; 56 of these procedures were emergencies for unco ntrolled variceal haemorrhage. Four of these 56 patients developed fea tures of acute liver failure, with marked deterioration in liver funct ion tests and elevated intracranial pressure, This unusual but importa nt complication of transjugular intrahepatic portosystemic stent-shunt has not been reported in the literature previously, and may have impo rtant consequences both for clinical practice and in the provision of further clues to understanding the pathogenesis of increased intracran ial pressure in patients with liver diseases.