AUTHOR=Tang Wei , Dawkins Makeda , Kumar Anila , Nasereldin Mohammed , Heering Gabriel , Soffler Morgan , Wolf David C. 

TITLE=Case Report: 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

JOURNAL=Frontiers in Gastroenterology

VOLUME=Volume 4 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/gastroenterology/articles/10.3389/fgstr.2025.1542588

DOI=10.3389/fgstr.2025.1542588

ISSN=2813-1169

ABSTRACT=Intracranial hypertension (ICH) is a well-recognized and potentially fatal complication of acute liver failure. It is rarely observed in patients with chronic liver disease or acute-on-chronic liver failure (ACLF). Only a few studies have investigated the management of ICH in ACLF. Here, we present an uncommon case of acute-onset severe hyperammonemia in a patient with cirrhosis who developed fulminant ICH. Rapid institution of renal placement therapy and therapeutic plasma exchange achieved a dramatic reduction in the serum ammonia level, but did not slow the patient’s rapid neurological deterioration.