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Early diagnosis and management of cerebral edema in acute liver failure is important to reduce neurological complication and mortality. Ammonia-induced astrocyte swelling and increased blood brain barrier permeability via transmembrane dysfunction are major mechanisms of cerebral edema in acute liver failure. Conventional therapy can be used to lower intracranial pressure. In addition, various treatment options are available to reduce serum ammonia level. Herein, we described the pathophysiology, monitoring, and management of cerebral edema in acute liver failure.