Stages of hepatic encephalopathy, children 3 to 18 years

Stage	Clinical	Reflexes	Neurologic signs	EEG changes
0	None	Normal	Psychological testing only	Normal
I	Confused, mood changes, altered sleep habits, loss of spatial orientation, forgetful	Normal or hyperreflexic	Tremor, apraxia, impaired handwriting	Normal or diffuse slowing to theta rhythm, triphasic waves
II^*	Drowsy, inappropriate behavior, decreased inhibitions	Hyperreflexic	Dysarthria, ataxia	Abnormal generalized slowing, triphasic waves
III^*	Stuporous, obeys simple commands	Hyperreflexic, upgoing toes (Babinski sign)	Rigidity	Abnormal generalized slowing, triphasic waves
IV	Comatose, arouses with painful stimuli (IVa), or no response (IVb)	Usually absent	Decerebrate or decorticate	Abnormal, very slow delta activity

EEG: electroencephalography.

* Asterixes is a common feature of stages II and III encephalopathy in adults but may be difficult to assess in children.

From: Ng VL, Li R, Loomes KM, et al. Outcomes of children with and without hepatic encephalopathy from the Pediatric Acute Liver Failure (PALF) Study Group. J Pediatr Gastroenterol Nutr 2016; 63:357. https://onlinelibrary.wiley.com/doi/10.1097/MPG.0000000000001178. Copyright © 2016 ESPGHAN and NASPGHAN. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

Graphic 134883 Version 5.0

خرید پکیج

Stages of hepatic encephalopathy, children 3 to 18 years