{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:43:56Z","timestamp":1789983836959,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,7,12]],"date-time":"2013-07-12T00:00:00Z","timestamp":1373587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Acute\u2010on\u2010chronic liver failure (<jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content>) has a rapidly progressive disease course associated with significant mortality. The prevalence of clinically significant cerebral oedema in <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We aimed to describe the prevalence of cerebral oedema in a cohort of <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> adult (&gt;18\u00a0years). We identified patients admitted to a single, specialist intensive care unit between January 2005 and January 2011 with high\u2010grade hepatic encephalopathy (\u22653) and a clinical picture of either <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> or chronic liver disease (<jats:styled-content style=\"fixed-case\">CLD<\/jats:styled-content>). Patients who had undergone cranial <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> imaging were identified and their imaging reviewed. The <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CLD<\/jats:styled-content> groups were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One thousand and eight patients with <jats:styled-content style=\"fixed-case\">CLD<\/jats:styled-content> were admitted. One hundred and seventy\u2010three patients (110 male) underwent neuroimaging. Eighty\u2010one (48 male) fulfilled criteria for <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content>. Variceal bleeding (30%) and sepsis (31%) were the most frequent precipitants of <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content>. Of those with neuroimaging from the total cohort, 30% of <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scans were normal, 30% demonstrated increased cerebral atrophy for age, 17% small vessel disease and 16% intracranial haemorrhage (<jats:styled-content style=\"fixed-case\">ICH<\/jats:styled-content>). Cerebral oedema was seen in three patients with <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> only. An increased prevalence of <jats:styled-content style=\"fixed-case\">ICH<\/jats:styled-content> was observed in the <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> group (23% vs. 9%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The prevalence of clinically relevant cerebral oedema was low (4%) but fatal. Death was attributable to tonsillar herniation. An increased prevalence of <jats:styled-content style=\"fixed-case\">ICH<\/jats:styled-content> was seen in <jats:styled-content style=\"fixed-case\">ACLF<\/jats:styled-content> patients and remains an important differential.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12257","type":"journal-article","created":{"date-parts":[[2013,6,20]],"date-time":"2013-06-20T13:52:55Z","timestamp":1371736375000},"page":"362-366","source":"Crossref","is-referenced-by-count":59,"title":["Cerebral oedema is rare in acute\u2010on\u2010chronic liver failure patients presenting with high\u2010grade hepatic encephalopathy"],"prefix":"10.1111","volume":"34","author":[{"given":"Deepak","family":"Joshi","sequence":"first","affiliation":[{"name":"Institute of Liver Studies King's College Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"O'Grady","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies King's College Hospital London 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