Table 7.3-4. West Haven criteria for grading the severity of hepatic encephalopathy


Neurocognitive manifestations


Increased incidence of motor-vehicle accidents, decreased quality of life, abnormal psychometric or neuropsychological examination 


Mild cognitive and behavioral impairment that is different from patient’s baseline. Manifested by disordered sleep, impaired attention span, mild confusion with intact orientation to time and space. Mild asterixis possible


Lethargy, moderate confusion, slurred speech, asterixis, dyspraxia, personality changes, disorientation to time


Stupor with intact arousability to stimuli, gross disorientation to time and space, incoherent speech. Clonus, nystagmus, Babinski sign, or rigidity may be seen on physical examination


Comatose state that does not respond to any stimuli, including pain

Adapted from Hejazifar N, Bajaj JS. Hepatic Encephalopathy. Reference Module in Biomedical Sciences. Elsevier; 2019.

MHE, minimal hepatic encephalopathy.