PDF(Pubmed)
Abstract：
UNASSIGNED: Acute liver failure (ALF) is a rapidly progressing, life-threatening syndrome characterized by liver-related coagulopathy and hepatic encephalopathy (HE). Given that higher HE grades correlate with poorer outcomes, clinical management of ALF necessitates close neurological monitoring. The primary objective of this case report is to highlight the diagnostic value of utilizing multimodal neuromonitoring (MNM) in a patient suffering from ALF.
UNASSIGNED: A 56-year-old male patient with a history of chronic alcoholism, without prior chronic liver disease, and recent acetaminophen use was admitted to the hospital due to fatigue and presenting with a mild flapping tremor. The primary hypothesis was an acute hepatic injury caused by acetaminophen intoxication. In the following hours, the patient\'s condition deteriorated, accompanied by neurological decline and rising ammonia levels. The patient\'s neurological status was closely monitored using MNM. Bilaterally altered pupillary light reflex assessed by decreasing in the Neurological Pupil Index values, using automated pupillometry, initially suggested severe brain oedema. However, ultrasound measurements of the optic nerve sheath diameter showed normal values in both eyes, P2/P1 noninvasive intracranial pressure waveform assessment was within normal ranges and the cerebral computed tomography-scan revealed no signs of cerebral swelling. Increased middle cerebral artery velocities measured by Transcranial Doppler and the initiation of electroencephalography monitoring yielded the presence of status epilepticus.
UNASSIGNED: The utilization of MNM facilitated a more comprehensive understanding of the mechanisms underlying the patient\'s clinical deterioration in the setting of HE. Nonetheless, future studies are needed to show feasibility and to yield valuable insights that can enhance the outcomes for patients with HE using such an approach. Given the absence of specific guidelines in this particular context, it is advisable for physicians to give further consideration to the incorporation of MNM in the management of unconscious patients with ALF.
UNASSIGNED: A 56-year-old male patient with a history of chronic alcoholism, without prior chronic liver disease, and recent acetaminophen use was admitted to the hospital due to fatigue and presenting with a mild flapping tremor. The primary hypothesis was an acute hepatic injury caused by acetaminophen intoxication. In the following hours, the patient\'s condition deteriorated, accompanied by neurological decline and rising ammonia levels. The patient\'s neurological status was closely monitored using MNM. Bilaterally altered pupillary light reflex assessed by decreasing in the Neurological Pupil Index values, using automated pupillometry, initially suggested severe brain oedema. However, ultrasound measurements of the optic nerve sheath diameter showed normal values in both eyes, P2/P1 noninvasive intracranial pressure waveform assessment was within normal ranges and the cerebral computed tomography-scan revealed no signs of cerebral swelling. Increased middle cerebral artery velocities measured by Transcranial Doppler and the initiation of electroencephalography monitoring yielded the presence of status epilepticus.
UNASSIGNED: The utilization of MNM facilitated a more comprehensive understanding of the mechanisms underlying the patient\'s clinical deterioration in the setting of HE. Nonetheless, future studies are needed to show feasibility and to yield valuable insights that can enhance the outcomes for patients with HE using such an approach. Given the absence of specific guidelines in this particular context, it is advisable for physicians to give further consideration to the incorporation of MNM in the management of unconscious patients with ALF.
摘要：
■急性肝衰竭（ALF）是一种快速发展的疾病，以肝脏相关凝血病和肝性脑病（HE）为特征的危及生命综合征。鉴于较高的HE评分与较差的结果相关，ALF的临床管理需要密切的神经系统监测。本病例报告的主要目的是强调在患有ALF的患者中使用多模式神经监测（MNM）的诊断价值。
■一名56岁的男性患者，有慢性酒精中毒史，以前没有慢性肝病，最近使用对乙酰氨基酚由于疲劳和出现轻度拍打性震颤而入院。主要假设是对乙酰氨基酚中毒引起的急性肝损伤。在接下来的几个小时里，病人的病情恶化，伴随着神经系统的衰退和氨水平的上升。使用MNM密切监测患者的神经状况。通过降低神经瞳孔指数值评估双侧改变的瞳孔光反射，使用自动瞳孔测量，最初提示严重的脑水肿。然而,超声测量视神经鞘直径显示两只眼睛的正常值，P2/P1无创颅内压波形评估在正常范围内，脑计算机断层扫描显示没有脑肿胀的迹象。经颅多普勒测量的大脑中动脉速度增加和脑电图监测的开始产生了癫痫持续状态的存在。
■MNM的使用促进了对患者在HE设置中临床恶化的潜在机制的更全面理解。尽管如此，需要未来的研究来证明可行性,并获得有价值的见解,以提高使用这种方法的HE患者的结局.鉴于在这种特殊情况下缺乏具体准则，建议医生进一步考虑将MNM纳入无意识ALF患者的管理。
■一名56岁的男性患者，有慢性酒精中毒史，以前没有慢性肝病，最近使用对乙酰氨基酚由于疲劳和出现轻度拍打性震颤而入院。主要假设是对乙酰氨基酚中毒引起的急性肝损伤。在接下来的几个小时里，病人的病情恶化，伴随着神经系统的衰退和氨水平的上升。使用MNM密切监测患者的神经状况。通过降低神经瞳孔指数值评估双侧改变的瞳孔光反射，使用自动瞳孔测量，最初提示严重的脑水肿。然而,超声测量视神经鞘直径显示两只眼睛的正常值，P2/P1无创颅内压波形评估在正常范围内，脑计算机断层扫描显示没有脑肿胀的迹象。经颅多普勒测量的大脑中动脉速度增加和脑电图监测的开始产生了癫痫持续状态的存在。
■MNM的使用促进了对患者在HE设置中临床恶化的潜在机制的更全面理解。尽管如此，需要未来的研究来证明可行性,并获得有价值的见解,以提高使用这种方法的HE患者的结局.鉴于在这种特殊情况下缺乏具体准则，建议医生进一步考虑将MNM纳入无意识ALF患者的管理。
