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September 16, 1961


JAMA. 1961;177(11):781. doi:10.1001/jama.1961.03040370043013

An important contribution to the study of neurological manifestations in hepatic coma was made by Frerichs in 1860.1 Dastur in a recent review2 calls attention to 2 important recent contributions to the subject of hepatic coma: In 1954, Wechsler and co-workers demonstrated lowered values for cerebral oxygen utilization and blood flow in hepatic coma,3 and these findings were confirmed by Fazekas and co-workers in a large group of patients.4 The fall in cerebral oxygen consumption in hepatic coma appears to cause a reduced cerebral arteriovenous oxygen difference in spite of slowed blood flow, though neither of the latter values showed a statistically significant difference from those recorded in alert subjects with hepatic insufficiency. These observations also suggest that reduction in cerebral oxygen consumption in hepatic insufficiency occurs gradually, beginning before neurological deficits become evident. A severe depression of cerebral oxygen utilization appears to be necessary for