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59 yo F, AMS 2 weeks, end stage liver disease, sepsis, seizures (no h/o anoxia)
FLAIR
FLAIR
DWI
DWI
ADC maps
ADC maps
Findings:
Diffuse cortical edema and restricted diffusion with sparing of the perirolandic region
DDX:
Anoxic/hypoxic injury, toxicity, post ictal, hyperammonemia
Diagnosis:
Hyperammonemia
Discussion:
Sparing of perirolandic cortex is characteristic of hyperammonemia
Submitted by Paritosh Khanna, MD, UW Neuroradiology Fellow