. 2020 Apr 29;9:F1000 Faculty Rev-312. [Version 1] doi: 10.12688/f1000research.22183.1

Table 1. WHC and ISHEN classification (modified according to Vilstrup et al. ¹).

WHC grade	ISHEN	Clinical features
Unimpaired		No present or previous HE
Minimal	Covert	Alterations of psychometric or neuropsychological tests (i.e. PHES, CFF, EEG) without clinical manifestations
Grade I	Covert	• Trivial lack of awareness • Euphoria or anxiety • Shortened attention span • Impairment of addition or subtraction • Altered sleep rhythm
Grade II	Overt	• Lethargy or apathy • Disorientation for time • Obvious personality change • Inappropriate behavior • Dyspraxia • Asterixis
Grade III		• Somnolence to semi-stupor • Responsive to stimuli • Confused • Gross disorientation • Bizarre behavior
Grade IV		Coma

CFF, Critical Flicker Frequency; EEG, electroencephalography; HE, hepatic encephalopathy; ISHEN, International Society for Hepatic Encephalopathy and Nitrogen Metabolism; PHES, Psychometric Hepatic Encephalopathy Score; WHC, West Haven Criteria.

Table 1. WHC and ISHEN classification (modified according to Vilstrup et al. 1).

Table 1. WHC and ISHEN classification (modified according to Vilstrup et al. ¹).