Patient 3. Patient 3. A 55-year-old man with severe sepsis of unknown origin (positive blood cultures for Enterococcus species) with a background of schizophrenia,

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High-signal-intensity lesions on T2-weighted MR images

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Presentation transcript:

Patient 3. Patient 3. A 55-year-old man with severe sepsis of unknown origin (positive blood cultures for Enterococcus species) with a background of schizophrenia, chronic hepatitis C, portal hypertension, and esophageal varices. The patient had a reduced level of consciousness and seizures. His plasma ammonium level was 82 μmol/L. A−C, DWI (A and B) and FLAIR image (C) show high signal intensity in the insular and cingulate cortices (arrows) and the perirolandic cortex bilaterally (black arrowheads). There is also subtle high signal intensity in the subinsular regions. With conservative therapeutic measures, the patient gradually improved neurologically, his plasma ammonium level decreased to 50 μmol/L, but he had significant residual intellectual impairment. D, Follow-up brain CT after 1 month showed widening of Sylvian fissures bilaterally (white arrowheads) in keeping with insular atrophy. J.M. U-King-Im et al. AJNR Am J Neuroradiol 2011;32:413-418 ©2011 by American Society of Neuroradiology