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Lancet. 1994 May 28;343(8909):1329-30.

Recovery despite impaired cerebral perfusion in fulminant hepatic failure.

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  • 1Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.


We report 4 patients with fulminant hepatic failure who developed prolonged intracranial hypertension (> 35 mm Hg for 24-38 h) that was refractory to standard therapy and associated with impaired cerebral perfusion pressure (< 50 mm Hg for 2-72 h). All survived with complete neurological recovery. Refractory elevation of intracranial pressure and reduced cerebral perfusion pressure are generally thought to contra-indicate liver transplantation in hepatic failure and are indications to withdraw support. Our observations challenge this concept.

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