MRI FINDINGS ASSOCIATED WITH ACUTE LIVER FAILURE

• DOI: 10.1212/wnl.0b013e3181aa5340
• Publication Date: 2009-06-15T20:27:00Z
• Authors: Vera Fridman; Steven L. Galetta; Amy A. Pruitt; Joshua M. Levine
• Keywords: Adult; Male; Brain; Brain Edema; Suicide, Attempted; Recovery of Function; Analgesics, Non-Narcotic; Liver Failure, Acute; Magnetic Resonance Imaging; Nerve Fibers, Myelinated; 3. Good health; 03 medical and health sciences; Diphenhydramine; 0302 clinical medicine; Predictive Value of Tests; Hepatic Encephalopathy; Tachycardia; Hypertension; Nerve Degeneration; Humans; Hypnotics and Sedatives; Coma; Acetaminophen

Acute liver failure (ALF) has a mortality rate of 50% to 90%.1 Acetaminophen overdose accounts for nearly cases and is the commonest cause ALF in United States Kingdom.2 Cerebral edema among most serious complications one leading causes death.1

Cranial MRI findings associated with are poorly characterized. We report clinical radiographic patient acetaminophen-induced discuss its potential pathophysiologic mechanisms.

### Case report.

A 28-year-old man was brought emergency room disorientation 4–6 hours after ingesting 50 g acetaminophen, 4 diphenhydramine, an unknown quantity alcohol suicide attempt. Examination notable hypertension, tachycardia, tachypnea. The had flat affect, but alert fully oriented. His pupils were dilated (7 mm) nonreactive. neurologic examination otherwise unremarkable Glasgow Coma Scale score 15. Serum acetaminophen level 156 mg/L, creatinine 1.4 mg/dL, total bilirubin 6.3 aspartate aminotransferase 1,051 μ/L, alanine 1,032 ammonia 108 μmol/L, platelet count 79,000/μL, international normalized ratio 3.4, anion gap …