CEREBRAL EDEMA AND INCREASED INTRACRANIAL-PRESSURE IN CHRONIC LIVER-DISEASE

Background Cerebral oedema is a cause of morbidity and mortality in fu lminant hepatic failure but has not been well documented as a complica tion of chronic liver diseases. We report here the development of cere bral oedema and increased intracranial pressure in 12 patients with ch ronic liver disease. Methods Between July 1, 1987, and Dec 31, 1993, w e studied 12 patients aged 29-67 years with end-stage chronic liver di sease. All the patients had cirrhosis. portal hypertension, hypoprothr ombinaemia, hepatic encephalopathy, and decreased serum concentrations of albumin (<25 g/L). During the study, the patients developed signs of increased intracranial pressure and had documented intracranial hyp ertension, cerebral oedema, or both. Intracranial hypertension was sus pected on physical examination and confirmed by epidural catheters. We detected cerebral oedema by computed axial tomography of the head and necropsy of the brain when possible. Findings All the patients had in tracranial hypertension and cerebral oedema. Two patients had successf ul treatment of cerebral hypertension with improvement of intracranial pressure such that orthotopic liver transplantation was undertaken. B oth patients became neurologically normal after transplantation. Eight patients had only a transient reponse to treatment and died of cerebr al oedema before a transplant could be done. Interpretation Cerebral o edema and increased intracranial pressure can occur in chronic liver d isease and presents as neurological deterioration. Treatment guided by monitoring of intracranial pressure can lead to the reversal of intra cranial hypertension, but in most patients cerebral oedema contributes to death or places them at too high a risk for liver transplantation.