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Background: Hepatic encephalopathy is usually accompanied by high signal intensities in the bilateral globus pallidus and the cerebral peduncle on T1-weighted brain images. Here, we present a case of fulminant hepatic failure along with hyperammonemia. Case Report: A 47-year-old man was admitted to our hospital due to decreased mental status. The laboratory tests showed increased aspartate transaminase, alanine transaminase, total bilirubin, ammonia levels and positive hepatitis A virus IgM antibody. Diffusionweighted brain imaging revealed high signal intensities in diffuse cortical areas, including the insular cortex, cingulate gyrus, and bilateral thalami. However, there was no involvement of the perirolandic area and the occipital cortex. We diagnosed the patient with hyperammonemic encephalopathy with fulminant hepatitis A infection. Conclusion: We described a case of hyperammonemic encephalopathy with diffuse cerebral and thalamic involvement. This case emphasized the obvious implication that signal changes in the insular cortex and the cingulate gyrus could be a ‘sentinel sign’, and increased diffuse cortical and thalamic involvement may point to a more severe status. J Neurocrit Care 2016;9(1):37-40

Hyperammonemic Encephalopathy with Diffuse Cortical and Thalamic Signal Changes on Diffusion-Weighted Brain MRI