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

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