Classification of Hepatic Encephalopathy in Japan Based on the Inuyama Symposium

Key Findings

Other Findings

Grade

inversion of sleep pattern; altered mood (euphoria and/or depression)

sloppy attitude; short attention span

I

disoriented to time or place; confusion about objects; variable somnolence; follows instructions

inappropriate behaviors; may be impolite; flapping tremor may be present

II

severely disoriented; excitation and/or delirium; sleeping most of time but rousable; cannot follow instructions but may follow simple orders

may show defiant behavior; opens eyes in response to stimulation; flapping tremor present; incontinent of urine and/or stool

III

comatose, responds to painful stimuli

brushes off hands; frowns in response to stimuli

IV

deep coma, unresponsive to painful stimuli

V