Hepatic encephalopathy is clinically categorized into five stages: stage 0 latent stage, stage 1 prodromal stage, stage 2 pre-comatose stage, stage 3 somnolent stage, and stage 4 comatose stage.
Hepatic encephalopathy can be staged according to whether the patient is accompanied by fluttering tremor, electroencephalogram examination, examination of pathological signs, examination of dystonic tendon reflexes, and judgment of central functions.
Stage 1.0 i.e. latent stage: no fluttering tremor, normal electroencephalogram, no positive pathological signs, normal dystonia and tendon reflexes, no behavioral and personality abnormalities only mental intelligence abnormalities.
2.1 Prodromal stage: fluttering tremor, abnormal electroencephalogram, no positive pathological signs, normal muscle tone and tendon reflexes, mild personality and mental abnormality (e.g., anxiety, amnesia, sleep reversal).
3.2 Pre-comatose stage: fluttering tremor, abnormal electroencephalogram, positive pathological signs, increased muscle tone and tendon reflexes, behavioral abnormalities and disorientation, drowsiness and confusion.
4.3 Coma stage: fluttering tremor, abnormal EEG, positive pathological signs, increased muscle tone and tendon reflexes, drowsiness that can be awakened but confusion.
5.4 Coma stage: no fluttering tremor, abnormal electroencephalogram, no positive pathological signs, increased muscle tone and tendon reflexes in shallow coma and decreased in deep coma, and inability to be awakened during coma.