Acute severe hepatic encephalopathy

Case contributed by Dr Andrew Dixon

Presentation

Alcoholic patient presenting with confusion and reduced conscious state.

Patient Data

Age: 60
Gender: Male

Diffuse cortical T2 and DWI hyperintensity with sparing of the perirolandic and occipital regions. Oedema within the thalami and posterior limbs of the internal capsules. Basal ganglia T1 hyperintensity. 

Case Discussion

An example of acute severe hepatic encephalopathy showing the classic pattern of diffuse cortical oedema with sparing of the perirolandic and occipital regions. The typical T1 hyperintense basal ganglia changes of chronic hepatic encephalopathy are also demonstrated. 

Creutzfeldt-Jakob disease would be an important differential to consider for cortical and thalamic signal changes like this in the absence of any known liver disease, although in this case the perirolandic and occipital lobe sparing is relatively pathognomonic of hepatic encephalopathy.  

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Case information

rID: 39037
Case created: 17th Aug 2015
Last edited: 19th Aug 2016
Inclusion in quiz mode: Included

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