Grading of Enchephalopathy

Stage	Clinical manifestation	
I
	Changes in humor and personality, disturbed sleep-wake cycle, difficulty in writing, fetor hepaticus, asterixis	
II
	Mild disorientation, inappropriate behavior, speech disturbance, ataxia, hyporeflexia 	
III
	Disorientation, amnesia, very sleepy but arousable, incoherent speech, marked asterixis, hyperreflexia, cloniae, rigidity	
IV
	A: Responsive to pain, hypotonia, hyporeflexia, hyperventilation
B: Not responsive, decorticated or decerebrated