Case Of the Week (COW) 08 November 2015
Chronic hepatic encephalopathy
Findings
T1 hyperintensity noted in the anterior pitutary. Volume loss and encephalomalasia noted the right temporoparietal region. Chronic infarct right gangliocapsular region. Diagnosis-chronic hepatic encephalopathy.(patient diagnosed as chronic buddchairi syndrome.)
Discussion
Hepatic encephalopathy is a spectrum of neuropsychiatric abnormalities occurring in patient with liver dysfunction.main pathology due to hyperammonemia.Classical MR imaging abnormalities in chronic HE include high signal intensity in the globus pallidum, substantia nigra on T1-weighted images, due to increased tissue concentrations of manganese, and an elevated glutamine/glutamate peak coupled with decreased myo-inositol and choline signal on proton MR spectroscopy,representing disturbances in cell-volume homeostasis secondary to brain hyperammoniemia . T1 hyperintensity has also been reported in the pituitary gland and hypothalamus but is less common. Isolated T1hyperintensity in anterior pitutary gland seen in autoimmune hepatitis sclerosing cholangitis and idiopathic copper intoxication.
Contributed By:
Prof. Babu Peter
Barnard Institute of Radiology
Chronic hepatic encephalopathy
Findings
T1 hyperintensity noted in the anterior pitutary. Volume loss and encephalomalasia noted the right temporoparietal region. Chronic infarct right gangliocapsular region. Diagnosis-chronic hepatic encephalopathy.(patient diagnosed as chronic buddchairi syndrome.)
Discussion
Hepatic encephalopathy is a spectrum of neuropsychiatric abnormalities occurring in patient with liver dysfunction.main pathology due to hyperammonemia.Classical MR imaging abnormalities in chronic HE include high signal intensity in the globus pallidum, substantia nigra on T1-weighted images, due to increased tissue concentrations of manganese, and an elevated glutamine/glutamate peak coupled with decreased myo-inositol and choline signal on proton MR spectroscopy,representing disturbances in cell-volume homeostasis secondary to brain hyperammoniemia . T1 hyperintensity has also been reported in the pituitary gland and hypothalamus but is less common. Isolated T1hyperintensity in anterior pitutary gland seen in autoimmune hepatitis sclerosing cholangitis and idiopathic copper intoxication.
Contributed By:
Prof. Babu Peter
Barnard Institute of Radiology