Cerebrospinal Fluid Protein Concentration in Hepatic Coma

Abstract

<h3>To the Editor.—</h3> We have recently cared for a patient with alcohol-induced cirrhosis of the liver and hepatic coma who manifested an elevated cerebrospinal fluid (CSF) protein concentration as the sole other abnormal finding. Because of this laboratory finding, further studies were carried out and the patient was eventually found to have cryptococcal meningitis in addition to hepatic coma. With appropriate therapy, the patient improved. This case directed our attention to CSF protein concentration in hepatic coma. There are very few published reports on CSF protein concentration in hepatic coma and these are conflicting.^1,2The standard current textbooks in internal medicine, neurology, and gastroenterology do not address themselves to this issue. Two exceptions are the discussions by Sherlock and Fishman wherein it is mentioned that CSF protein concentration in hepatic coma may be increased.^3-4The frequency and magnitude of the elevated protein concentration, however, are not mentioned. In