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CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2023; 59(04): 225-228
DOI: 10.1055/s-0043-1777315
Case Reports

“Brain on Fire”: Hyperperfusion as a Hallmark of Hyperammonemic Encephalopathy

Sameer Peer 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India
,
Paramdeep Singh 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India
,
Ritish Gupta
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India
,
Priya Bhat
2   Department of Microbiology, Adesh Institute of Medical Sciences, Bathinda, Punjab, India
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Abstract

We describe a very rare case of acute fulminant hepatic failure as a complication of acute viral hepatitis caused by hepatitis A virus, complicated by hyperammonemic encephalopathy. The brain magnetic resonance imaging (MRI) findings were suggestive of cytotoxic edema involving bilateral cerebral hemispheres. The novel findings of hyperperfusion on arterial spin labeling perfusion MRI and hyperemic hypoxia on susceptibility weighted imaging are discussed. The patient had a rapid progression of cerebral edema and succumbed to the illness despite supportive care. Characteristic neuroimaging findings may help in the diagnosis of acute hyperammonemic encephalopathy of brain MRI, which may be useful in leading to appropriate clinical workup and diagnosis of the underlying cause of hyperammonemia. In our case, hyperammonemic encephalopathy was precipitated by fulminant hepatic failure caused by hepatitis A virus, which is a rare occurrence.

Keywords

hepatic encephalopathy - hyperammonemia - hepatitis

Ethics Statement

The authors declare that the manuscript conforms to the Declarations of Helsinki. Informed written consent was taken from the guardians of the patient for data acquisition and publication.


Authors' Contribution

S.P. contributed to drafting of the manuscript and data acquisition. P.S. contributed to data acquisition, and approval of the final draft of the manuscript. R.G. contributed to drafting of the manuscript and approval of the final draft of the manuscript. P.B. contributed to data collection and approval of the final draft of the manuscript.




Publication History

Article published online:
18 December 2023

© 2023. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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