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
