Evaluation and management of neurological complications in acute liver failure

Abstract

Neurological complications in acute liver failure are the most common cause of mortality in this group of patients. Almost all neurologic complications arise from underlying increase in intracranial pressure in ALF. In addition to symptomatic management, the treatment relies on measures to bring down ICP. Recently role of renal replacement therapy is gaining a lot of ground in ALF management, primarily due to its ammonia lowering effects indirectly leading to decrease in ICP. In this review we cover the neurologic issues in ALF in detail. We discuss the various non invasive techniques for ICP monitoring & their current application in ALF patients. We also focus on the management protocols in ALF & their role in improving the ICP & hence the outcome.

Keywords: Acute Liver Failure; Neurologic complications; ONSD; Plasma exchange; Renal replacement therapy.