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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Acute fulminant hepatic failure, encephalopathy and early CT changes
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Acute fulminant hepatic failure, encephalopathy and early CT changes

机译：急性暴发性肝衰竭，脑病和早期CT改变

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Background: Acute fulminant hepatic failure (AFHF) is common in tertiary care centres with transplant facilities. Cerebral edema frequently threatens the lives of such patients. We reviewed our cases of AFHF, noting the incidence of cerebral edema with serial CT scans and factors associated with mortality. Methods: Patients were captured through HmRI classification of acute liver/hepatic failure. Chart review included tabulation of: demographics, INR; serum bilirubin, creatinine, albumin; in-hospital mortality. Computed tomogram (Ct) scans were re-read with blinding to clinical information and catalogued for changes in sulcal markings, ventricular size and grey-white differentiation (GWD). Inclusion criteria: age equal to or greater than 16 years, encephalopathy, hepatic failure within eight weeks of onset of liver disease, CT scans of head performed. Results: Of our 25 cases with AFHF, acetaminophen toxicity was the most common etiology (nine cases). Twelve of the 25 patients (48%) had cerebral edema on CT, including eight of the nine (89%) with acetaminophen toxicity. Decrease in sulcal markings and ventricular size preceded conspicuous alterations in GWD. Fourteen died, including all 12 with cerebral edema, although death was due to herniation in only one patient. None of the hematological or biochemical variables correlated significantly with mortality. Conclusions: Acetaminophen toxicity is a common cause of AFHF; this combination has a strong association with cerebral edema. Cerebral edema can be detected in its early stages and followed by baseline and serial CT scans. This facilitates management to prevent fatal brain herniation.
机译：背景：在具有移植设施的三级医疗中心，急性暴发性肝衰竭（AFHF）很常见。脑水肿经常威胁这类患者的生命。我们回顾了AFHF病例，通过连续CT扫描和与死亡率相关的因素记录了脑水肿的发生率。方法：通过HmRI分类法对急性肝/肝衰竭患者进行捕获。图表审查包括以下表格：人口统计，INR;血清胆红素，肌酐，白蛋白;住院死亡率。在不了解临床信息的情况下，重新读取了计算机断层扫描（Ct）扫描，并分类记录了脑沟标记，心室大小和灰白色分化（GWD）的变化。纳入标准：年龄等于或大于16岁，脑病，肝病发作后八周内肝功能衰竭，头部CT扫描。结果：在我们的25例AFHF患者中，对乙酰氨基酚毒性是最常见的病因（9例）。 25名患者中有12名（48％）在CT上出现脑水肿，其中9名中的8名（89％）具有对乙酰氨基酚毒性。在GWD发生明显改变之前，脑沟标记和心室大小的减少。尽管只有一名患者死于椎间盘突出，但有14例死亡，包括全部12例脑水肿。血液学或生化指标均未与死亡率显着相关。结论：对乙酰氨基酚毒性是引起AFHF的常见原因。这种组合与脑水肿有很强的联系。可以在早期发现脑水肿，然后进行基线和连续CT扫描。这有助于防止致命性脑疝的治疗。

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