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Acute hepatic encephalopathy with diffuse cortical lesions.

S M Arnold1, T Els, J Spreer

  • 1Section of Neuroradiology, University of Freiburg, Germany. sarnold@uhbs.ch

Neuroradiology
|August 22, 2001
PubMed
Summary

Acute hepatic encephalopathy, a complex syndrome, can lead to coma due to gastrointestinal bleeding in patients with alcoholic cirrhosis. This case highlights toxic cortical laminar necrosis as a severe complication.

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Area of Science:

  • Neurology
  • Gastroenterology
  • Radiology

Background:

  • Acute hepatic encephalopathy (AHE) is a poorly understood syndrome with diverse causes.
  • Alcoholic cirrhosis and hereditary hemorrhagic telangiectasia are significant comorbidities.
  • Severe gastrointestinal bleeding can precipitate acute hepatic coma.

Observation:

  • A 49-year-old woman with alcoholic cirrhosis and hereditary hemorrhagic telangiectasia presented with acute hepatic coma.
  • Elevated blood ammonia levels were detected.
  • Magnetic Resonance Imaging (MRI) revealed chronic hepatic encephalopathy lesions and acute cortical signal changes.

Findings:

  • The MRI findings showed widespread cortical signal changes, sparing specific regions.
  • These cortical lesions were consistent with hypoxic brain damage.

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  • The observed lesions were interpreted as acute toxic cortical laminar necrosis.

    • Implications:

    • This case underscores the severe neurological complications of acute hepatic encephalopathy.
    • Toxic cortical laminar necrosis is a critical finding in hepatic coma.
    • Understanding these mechanisms is vital for managing patients with liver disease and gastrointestinal bleeding.