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|Written by mpmom|
|08 August 2008|
In patients with cirrhosis and overt encephalopathy, two
staging classifications have been used for patients with HE.
1. The West Haven criteria of altered mental state in HE (20)
(numerous studies have employed variations of these criteria).Stage 0. Lack of detectable changes in personality or
behavior. Asterixis absent.Stage 1. Trivial lack of awareness. Shortened attention
span. Impaired addition or subtraction. Hypersomnia,
insomnia, or inversion of sleep pattern. Euphoria or
depression. Asterixis can be detected.Stage 2. Lethargy or apathy. Disorientation. Inappropriate
behavior. Slurred speech. Obvious asterixis.Stage 3. Gross disorientation. Bizarre behavior. Semistupor
to stupor. Asterixis generally absent.Stage 4. Coma.
2. Evaluation of the level of consciousness with the Glasgow
Scale (21) (Table 1): although the Glasgow coma scale
has not been rigorously evaluated in patients with HE, its
widespread use in structural and metabolic disorders of
brain function justifies its application in acute and chronic
AJG – July, 2001 Hepatic Encephalopathy 1969