TABLE 1.

West haven criteria for HE

Grade	Description
Grade I	Mild confusion Very mild lack of awareness, short attention span Slurred speech Problems with sleep Mood changes (euphoria, anxiety, depression)
Grade II	Moderate confusion, disorientation to time (“What time of day is it?”) Lethargy or apathy Personality changes Asterixis (hand flapping occurring with arm extension and wrist flexion) Dyspraxia (trouble planning and coordinating muscles to complete a task)
Grade III	Marked confusion, confusion about place (“Where am I?”) Extreme sleepiness, still responsive Strange behavior
Grade IV	Coma, does not respond to pain or shaking