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doi: 10.1038/nrneph.2015.180 118 PrincenHMvan DuyvenvoordeWBuytenhekRvan der LaarseAvan PoppelGGevers LeuvenJAet al

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The pupils of the patients with early HE are normal, with preserved responses, but in grade III or IV HE, the pupillary reaction becomes sluggish and is accompanied by a periodic lateral or dysconjugate gaze, or fixed gaze

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