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Case No. 717
2025-04-01~2025-04-30
출제자 : 임영희
Hit : 508
| Period | 2025-04-01~2025-04-30 |
|---|---|
| Diagnosis | hepatic encephalopathy (acute hyperammonemic encephalopathy, postosystemic encephalopathy) |
| Gender |
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| Age | 66 |
| Clinical information | 66/M Altered mentality Blood Ammonia 157 ㎍/dL ↑ (참고치 12~66) |
| Discussion | Extensive curvilinear DWI high SI lesion involving both cerebral cortical sulci and thalami. - with relatively spread bilateral insula, F-P and T-O cortices. - with FLAIR hyperintensities Acute hyperammonemic encephalopathy. Hepatic encephalopathy (acute hyperammonemic encephalopathy, postosystemic encephalopathy) - Spectrum of neuropsychiatric abnormalities, encompassing a wide spectrum of mental and motor disorders - Occurring patients with liver dysfunction and portal hypertension. - Results from exposure of brain to excessive amounts of ammonia MRI T1 High signal within the caudate nucleus, globus pallidus, putamen and anterior midbrain due to deposition of manganese T2/FLAIR High T2 signal in most of cerebral cortex (preferential insular cortex and cingulate gyri) , thalamus, posterior limbs of internal capsule Perirolandic/occipital regions relatively spared Reference Rovira A, Alonso J, Córdoba J. MR Imaging Findings in Hepatic Encephalopathy. AJNR Am J Neuroradiol. 2008;29(9):1612-21. Sharma P, Eesa M, Scott JN. Toxic and acquired metabolic encephalopathies: MRI appearance. AJR Am J Roentgenol. 2009;193 (3): 879-86. Diagnostic Imaging: Brain, 4th Edition - November 20, 2020, Author: Miral D. Jhaveri |
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