Question 2379
{"accessible":true,"alternatives":[{"id":11727,"text":"acute hepatic encephalopathy"},{"id":11726,"text":"acquired hepatocerebral degeneration"},{"id":11730,"text":"fat embolism syndrome"},{"id":11729,"text":"hypoglycemic encephalopathy"},{"id":11728,"text":"Wernicke encephalopathy"}],"archived":false,"correctAlternativeId":11727,"explanation":"\u003cp\u003eThe diffusion-weighted image shows hyperintensity of the insulae (cortical and subcortical) and thalami, and to a lesser extent other cortical areas, a pattern most supportive of acute \u003ca title=\"Hepatic encephalopathy\" class=\"internal\" href=\"/articles/hepatic-encephalopathy\"\u003ehepatic encephalopathy\u003c/a\u003e in this\u0026nbsp;clinical setting of acute liver failure. The differential includes periictal/postictal changes.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Acquired hepatocerebral degeneration\" class=\"internal\" href=\"/articles/acquired-hepatocerebral-degeneration\"\u003eAcquired hepatocerebral degeneration\u003c/a\u003e is incorrect because it should manifest with movement or neurocognitive disorders in the setting of chronic liver disease, which are not present in this case. The main signal abnormality in this condition is\u0026nbsp;T1 hyperintensity of the globi pallidi, which is not shown here.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Wernicke encephalopathy\" class=\"internal\" href=\"/articles/wernicke-encephalopathy\"\u003eWernicke encephalopathy\u003c/a\u003e could occur following hyperemesis gravidarum but is incorrect\u0026nbsp;in this case because the sites of involvement should be around the third and fourth ventricles but not cortical.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Hypoglycemic encephalopathy (HE)\" class=\"internal\" href=\"/articles/hypoglycaemic-encephalopathy\"\u003eHypoglycemic encephalopathy \u003c/a\u003ecould manifest with cortical diffusion restriction but is incorrect because the thalami are typically spared in adults with this condition. This patient did not have documented hypoglycemia.\u003c/p\u003e\u003cp\u003e\u003ca title=\"Fat embolism syndrome\" class=\"internal\" href=\"/articles/fat-embolism-syndrome\"\u003eFat embolism syndrome\u003c/a\u003e has rarely been reported in association with acute fatty liver of pregnancy but is incorrect because the imaging findings of cerebral fat embolism are\u0026nbsp;scattered minute foci of restricted diffusion and microhemorrhages, which are not shown here.\u003c/p\u003e","id":2379,"imageUrl":"https://prod-images-static.radiopaedia.org/images/56023667/IMG-0004-00050_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":93495},"imageAttributionCaseInfo":{"title":"Acute severe hepatic encephalopathy","contributor_name":"Dalia Ibrahim","contributor_param":"dalia","case_rid":93495,"case_param":"acute-severe-hepatic-encephalopathy-1"},"firstQuestionPath":"/questions/2585","nextQuestionPath":null,"relatedArticles":[{"id":5627,"title":"Wernicke encephalopathy","link":"/articles/wernicke-encephalopathy?lang=us"},{"id":29525,"title":"Cerebral fat embolism","link":"/articles/cerebral-fat-embolism?lang=us"},{"id":37277,"title":"Hypoglycemic encephalopathy","link":"/articles/hypoglycaemic-encephalopathy?lang=us"},{"id":45917,"title":"Acquired hepatocerebral degeneration","link":"/articles/acquired-hepatocerebral-degeneration?lang=us"}],"alsoUsedIn":[{"id":1345,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1345","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1345"},{"id":1200,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1200","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1200"},{"id":248,"kind":"LiveSchedule","title":"248","link":"https://radiopaedia.org/admin/live_schedules/248"},{"id":156,"kind":"LiveSchedule","title":"156","link":"https://radiopaedia.org/admin/live_schedules/156"},{"id":1262,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1262","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1262"},{"id":1397,"kind":"RestrictedPage","title":"Page 1397 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/2238"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 20-year-old woman with severe vomiting and acute fatty liver of pregnancy, now post-delivery,\u0026nbsp;developed\u0026nbsp;seizures and coma and is assessed with the MRI shown. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2379"}],"attemptsPercentages":[{"alternativeId":"11728","percentage":21},{"alternativeId":"11730","percentage":2},{"alternativeId":"11727","percentage":59},{"alternativeId":"11729","percentage":11},{"alternativeId":"11726","percentage":7}],"promptToLogin":false,"questionManager":false,"articleId":"hepatic-encephalopathy"}