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Abstract: In this case study, we report the longitudinal and multimodal follow‐up of a catastrophic initial presentation of cerebral fat embolism syndrome. We show that despite the initial severity, the cognitive outcome was ultimately very good but with a highly nonlinear time‐course and prolonged loss of consciousness (more than 2 months). Repeated clinical assessments and brain‐imaging techniques (electroencephalography, event‐related potential, 18‐Fluoro‐Deoxy‐Glucose‐PET and magnetic resonance imaging) allowed us to monitor and anticipate this dynamic, providing relevant information to guide decision making in front of withdrawal of life‐sustaining therapy discussions. This case illustrates the value of multimodal functional imaging in devastating brain injuries. [ABSTRACT FROM AUTHOR]

Abstract: Hepatic encephalopathy (HE) influences short‐term and long‐term prognoses. Recently, glycerol phenylbutyrate (PB), that lowers ammonia by providing an alternate pathway to urea for waste nitrogen excretion, has shown that it was effective in preventing the occurrence of HE in RCT. The aim was to assess the benefits of sodium PB in cirrhotic patients admitted to ICU for overt HE, in terms of ammonia levels decrease, neurological improvement, and survival. Cirrhotic patients who presented with overt HE, ammonia levels >100 μmol/L, and did not display any contra‐indication were included. Sodium PB was administered at 200 mg/kg/day. Control group included historical controls treated by standard therapy, matched for age, sex, MELD score, and severity of HE. Eighteen patients were included and treated with sodium PB (age: 59 [45–68], male gender: 15 [83%], Child–Pugh B: 8 [44%], Child–Pugh C: 10 [56%], and MELD score: 16 [13–23]). Ammonia levels significantly decreased in the PB as compared to the control group from inclusion to 12 h and from inclusion to 48 h (P = 0.0201 and P = 0.0230, respectively). The proportion of patients displaying neurological improvement was only higher in the PB‐treated group as compared to controls at ICU discharge (15 [83%] vs. 9 [50%], P = 0.0339). ICU discharge survival was significantly higher in patients treated with PB (17 [94%] vs. 9 [50%], P = 0.0017). In cirrhotic patients with overt HE, sodium PB could be effective in reducing ammonia levels and might be effective in improving neurological status and ICU discharge survival. More extensive data, especially a RCT, are mandatory. [ABSTRACT FROM AUTHOR]