Acute and Chronic Magnetic Resonance Imaging (MRI) Head Scan Changes in Adult Hyperammonemic Encephalopathy: A Case Report

Angela Wabulya and Scott Newsome

Department of Neurology, University of North Carolina, USA
Department of Neurology, The Johns Hopkins University, USA

^*Correspondance to: Angela Wabulya 

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Abstract:

Hyperammonemic encephalopathy is a type of an acute toxic-metabolic encephalopathy resulting from elevated plasma ammonia levels. Increased ammonia may be due to a variety of etiologies, at times leading to acute and chronic brain changes. Acute and chronic clinical and radiographic changes are well documented in the pediatric population, however, there is a paucity of reports pertaining to chronic changes in the adult population. In some adult patients, complete resolution of acute changes or mild cerebral atrophy has been reported differing from the pediatric population where significant chronic changes including neurologic devastation have been documented. Furthermore, hyperammonemia in adults is often attributed to hepatic disorders or typically thought of triggers such as use of Depakote, whose absence may at times be associated with late detection. We present a patient with acute hyperammonemic encephalopathy secondary to newly diagnosed Ornithine Transcarbamylase (OTC) deficiency followed over a3-year period with persistent cognitive dysfunction and significant Magnetic Resonance Imaging (MRI) of the head abnormalities. Hyperammonemic encephalopathy should be confirmed by serologic testing, however, in the event, that brain imaging is obtained prior to this, certain features of MRI of head should raise one’s suspicion and prompt early diagnosis and management. This case will emphasize the need for prompt diagnosis, identification of the causes and treatment of acute hyperammonemic encephalopathy especially in the absence of commonly implicated causes, to mitigate further brain injury as well as hopefully avoiding a recurrence.

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Cite the Article:

Wabulya A, Newsome S. Acute and Chronic Magnetic Resonance Imaging (MRI) Head Scan Changes in Adult Hyperammonemic Encephalopathy: A Case Report. Ann Clin Case Rep. 2017; 2: 1309.