Table 2.

HE classification according to the severity of the manifestations.

WHC	ISHEN	Criteria
0 or unimpaired		No evidence or history of HE
Minimal	Covert	No clinically abnormalities detected
Grade I		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 semistupor Responsive to stimuli Confused Gross disorientation Bizarre behavior
Grade IV		Coma

HE, hepatic encephalopathy; ISHEN, International Society for Hepatic Encephalopathy and Nitrogen Metabolism; WHC, West Haven criteria.