Hepatic encephalopathy (HE) reflects a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of other known brain disease. Classification of hepatic encephalopathy is based on the clinical setting in which symptoms occur (Table 1).1 The encephalopathy of acute liver failure shares clinical characteristics with that of cirrhosis, but also exhibits unique features. In cirrhosis, three major syndromes can be present