Liver transplantation following decompressive craniectomy for intracerebral haemorrhage in acute liver failure during pregnancy.

We report the case of a previously healthy woman in her 20s, pregnant, who developed acute liver failure (ALF) of unknown aetiology, complicated by a large right parietal intracerebral haemorrhage and signs of intracranial hypertension. She underwent emergency neurosurgical interventions, including craniotomy and decompressive craniectomy, with subsequent neurological stabilisation under intensive neuroprotective care. Following a multidisciplinary evaluation, she was considered eligible for liver transplantation and underwent orthotopic liver transplant with favourable clinical and neurological outcomes. This case illustrates that, in selected scenarios, the presence of acute neurological complications does not preclude successful liver transplantation. It emphasises the importance of individualised, multidisciplinary decision-making and highlights how early surgical management, ongoing neurocritical care and timely transplant coordination can result in meaningful recovery. The case also contributes to the limited literature on the intersection of ALF, severe brain injury and transplant eligibility.