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





FLAIR



DWI                           



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

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