MASLD-Induced Hyperammonemia With Atypical, Restricted Diffusion Pattern Suggesting Mixed Metabolic and Hypoxic-Anoxic Injury

This case demonstrates a rare instance of neurologic and radiologic sequelae for a reported ammonia level of 450 μmol/L. Additionally, the rapidly down-trending ammonia levels with a standard bowel regimen and rectal tube suggest that the initial ammonia level may not have been as elevated. Neurologic imaging plays a key role in cirrhotic patients when metabolic correction fails to restore normal consciousness despite sometimes mixed and/or nonspecific restricted diffusion patterns.