Demographics:
62 years old, Male
Indication:
Obtunded, alcoholic cirrhosis
Findings
- Areas of restricted diffusion and T2/FLAIR hyperintensity in the right greater than left temporal lobes, bilateral hippocampi, bilateral insular cortices, bilateral cingulate gyri, and bilateral orbital frontal lobes
- Faint T2/FLAIR hyperintensity in the bilateral thalami
- Background of patchy subcortical and periventricular T2/FLAIR hyperintensity, advanced for age
- No mass effect, acute hemorrhage, or hydrocephalus
Diagnosis
Hyperammonemic encephalopathy
Sample Report
Multifocal restricted diffusion and T2/FLAIR hyperintensity involving the bilateral temporal lobes, hippocampi, insular cortices, cingulate gyri, orbital frontal lobes, and to a lesser extent the bilateral thalami, which most likely relates to hyperammonemia given clinical history, though encephalitis (including herpes encephalitis) could have a similar appearance. Age-advanced patchy subcortical and periventricular T2/FLAIR hyperintensity, which is nonspecific but commonly attributable to chronic small vessel disease. No mass effect, acute hemorrhage, or hydrocephalus.
Discussion