West Haven Criteria for Altered Mental Status in Hepatic Encephalopathy

West Haven criteria for altered mental status in hepatic encephalopathy

Grade 0 Minimal hepatic encephalopathy, lack of detectable changes in personality or behavior; no asterixis.

Grade 1 Trivial lack of awareness, shortened attention span, sleep disturbance, altered mood, and slowing the ability to perform mental tasks; asterixis may be present.

Grade 2 Lethargy or apathy, disorientation to time, amnesia of recent events, impaired simple computations, inappropriate behavior, and slurred speech; asterixis is present.

Grade 3 Somnolence, confusion, disorientation to place, bizarre behavior, clonus, nystagmus, and positive Babinski sign; asterixis usually absent.

Grade 4 Coma, lack of verbal, eye, and oral response to stimuli.

Reference

Emergency Management in Neurocritical Care: Chapter 17 Metabolic Encephalopathies, by Edward Manno

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