ABSTRACT
Intracranial hypertension secondary to brain edema is the most common cause of death in fulminant hepatic failure (FHF) patients, even when they are listed for urgent ortho topic liver transplantation (OLT).1 Brain edema is a complication of FHF. In a 1944 report o f 125 autopsies of FHF patients, Lucké did not find evidence of cerebral herniation.2 Cerebral edema was noted in a few cases, but his finding could in part be attributed to brain ischemia. The first reports of brain edema and cerebral herniation as FHF complications were published in the 1970s, but wide recognition of this complication came only in the 1980s.3'6 One possible explanation for the relatively recent recognition of this complication may be the advances in FHF patient care. Previously, FHF patients were dying from com plications o f early hepato-cellular insufficiency, mainly hemorrhage and sepsis.2 Improvements in intensive care techniques have enhanced the survival o f FHF patients. The longer course of the disease may result in development of brain edema, which may represent a later manifestation o f FHF. In the current management of FHF patients, intracranial hyper tension remains the greatest clinical challenge.
