Brain magnetic resonance imaging findings in hyperammonemic hepatic encephalopathy: A case series and literature review

Hyperammonemic encephalopathy is a life-threatening condition that can lead to coma and death due to brain edema and intracranial hypertension. The current study presents the clinical and magnetic resonance imaging (MRI) findings of 5 cases of acute hyperammonemic hepatic encephalopathy. MRI images of all 5 patients showed diffuse cortical swelling affecting the frontal, temporal, and parietal lobes, as well as the insular cortex and cingulate gyri. However, the underlying white matter, peri-rolandic area, and posterior occipital lobe remained unaffected. These specific brain MRI features are more commonly observed in cases with 165 µmol/l or higher ammonia levels, suggesting a potential correlation. Further studies are needed to confirm this association.