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59 yo F, AMS 2 weeks, end stage liver disease, sepsis, seizures (no h/o anoxia)

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