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Cerebral edema has now been noted to occur frequently in patients dying of fulminant hepatic failure. In the present study, intracranial pressure was monitored in an animal model of acute liver failure. Acute liver failure was induced surgically by hepatic devascularization. Serial monitoring of the electroencephalogram revealed progressive slowing of the frequency with decreasing amplitude. Elevation of the blood ammonia was also observed from baseline values of 64 +/- 12 SE to 744 +/- 97 mumol/liter. Monitoring of the intracranial pressure with a subdural pressure transducer demonstrated a progressive and reproducible rise from 12.8 +/- 2.5 mm Hg immediately after the operation to a mean value of 51.6 +/- 11.8 mm Hg just before death 6--12 hr later. At autopsy, the brains of the test animals were found to be swollen with flattened cortical gyri. In the control animals, intracranial pressure rose slightly but returned toward normal levels (8.0 +/- 2.5 mm Hg) 8 hr after laparotomy and remained normal until their death. There was a statistically significant difference between intracranial pressure levels of the test animals and those of the controls (P less than 0.01). Intravenous methylprednisolone (2.0 g initially followed by 0.5 g every 2 hr) administered immediately before and after hepatic devascularization prevented rises in intracranial pressure but had no effect when given 4 hr after operation. The early and progressive increase in intracranial pressure was an unexpected finding, and an assessment of such a sequence in patients with fulminant hepatic failure is currently in progress.
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
April 2019,
Neurocritical care,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
December 2007,
Hepatology (Baltimore, Md.),
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
October 2018,
Neurocritical care,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
June 2008,
Arquivos de neuro-psiquiatria,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
January 2006,
Critical care medicine,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
May 2017,
World journal of gastroenterology,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
November 2011,
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
August 2006,
Hepatology (Baltimore, Md.),
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
December 2018,
Neurocritical care,
M A Hanid, and
R L Mackenzie, and
R E Jenner, and
R A Chase, and
P J Mellon, and
P N Trewby, and
I Janota, and
M Davis, and
D B Silk, and
R Williams
August 2016,
Neurocritical care,
