 ClassificationGrading of HE can be classified as type A in Acute Liver Failure, B in Portosystemic shunts without intrinsic liver disease and C patients of cirrhosis with portal hypertensionor portosystemic shunts 5,6. In cirrhotics, the type C HE is further classified into Episodic, Persistent and Minimal HE. Chronic persistent overt HE patients are those who can be relatively stable with little day to day fluctuation in their mental status. Episodic Unstable HE patients are defined as those who were previously stable, but who over hours and possibly days develop clinically discernible features of HE, requiring medical attention and hospitalization. Minimal HE is clinically inapparent and detected by abnormal neuropsychometric or neurophysiological tests 3. 