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CASE REPORT article
Front. Gastroenterol.
Sec. Hepatology
Volume 4 - 2025 | doi: 10.3389/fgstr.2025.1542588
This article is part of the Research Topic Brain-Liver Axis and Glutamate Homeostasis - Volume II View all 3 articles
Management of Intracranial Hypertension in Acute-On-Chronic Liver Failure: A Case of Fulminant Cerebral Edema and Acute-Onset Severe Hyperammonemia in A Patient with Cirrhosis
Provisionally accepted
Wei Tang 1,2*
Dawkins Makeda 1,2 Anila Kumar 1,2 Mohammed Nasereldin 1,2 Gabriel Heering 1,2 Soffler Morgan 1,2 David Wolf 1,2- 1 Westchester Medical Center, Valhalla, United States
- 2 New York Medical College, Valhalla, New York, United States
Intracranial hypertension (ICH) is a well-recognized fatal complication of acute liver failure but rarely observed in patients with chronic liver disease or acute-on-chronic liver failure (ACLF). Hence, there has been a paucity of studies investigating appropriate management of ICH in ACLF. A variety of therapies have been adopted to manage ICH in ACLF despite scarce evidence including ammonia-reducing therapies. Here, we present an uncommon case of acuteonset severe hyperammonemia in a patient with cirrhosis who developed fulminant ICH and deteriorated rapidly despite remarkable reduction in serum ammonia levels with intensive management including continuous renal replacement therapy and therapeutic plasma exchange.
Keywords: Hyperammonemia, Hepatic Encephalopathy, Acute on chronic liver failure, cerebral edema, cirrhosis, Intracranial hypertension (ICH)
Received: 10 Dec 2024; Accepted: 18 Feb 2025.
Copyright: © 2025 Tang, Makeda, Kumar, Nasereldin, Heering, Morgan and Wolf. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Tang, Westchester Medical Center, Valhalla, United States
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