Diagnosis and Management of Intracranial Hypertension in Acute Liver Failure.

Acute liver failure is a rare disease characterized by acute presentation of liver injury in the absence of cirrhosis that poses significant morbidity and mortality. Neurological manifestations, including hepatic encephalopathy, cerebral edema and intracranial hypertension, are frequent. The incidence of intracranial hypertension in acute liver failure has declined, which is a likely reflection of the impact of early and adequate intervention, but it holds a poor prognosis. This review summarizes the key concepts relating to pathophysiology, diagnosis and management of intracranial hypertension in acute liver failure. Clinical and biochemical predictors aid in early recognition and use of prophylactic or targeted management. Validated invasive and noninvasive intracranial pressure monitoring are important in the management of intracranial hypertension. The use of invasive intracranial pressure monitoring in acute liver failure has been limited due to the expected risk of hemorrhage secondary to coagulopathy. The risk associated with invasive monitoring is better assessed with the use of viscoelastic testing when compared to conventional coagulation tests. Management of intracranial hypertension includes strategies that target the reduction of cerebral blood volume and cerebral volume.