Neuroradiology
October 17, 2026 · via Europe PMC
Neuroimaging findings in hyperammonemic encephalopathy associated with sepsis-induced liver injury: a pilot case series.
Talybov R, Trofimova T, Kleshchevnikova T, Statsenko Y
AI summary — for doctors, generated from the abstract only
In this small series of septic patients with hyperammonemic encephalopathy, brain MRI most often showed symmetric insular and cingulate involvement that largely regressed with treatment.
What was studied
Pilot descriptive case series of brain MRI in 15 consecutive patients with sepsis and clinically confirmed hyperammonemic encephalopathy from sepsis-induced liver injury, assessing lesion location, signal, diffusion restriction, susceptibility artifacts and reversibility; no control group.
Key findings
- All 15 patients had abnormal MRI; symmetrical insular cortex and cingulate gyrus involvement was the most frequent pattern (13/15, 86.7%)
- All lesions were hyperintense on T2-weighted and FLAIR images, with diffusion restriction suggesting cytotoxic edema
- Follow-up MRI in all patients showed marked regression after treatment adjustment and renal replacement therapy, alongside normalization of ammonia, transaminases, lactate and sepsis markers
Clinical relevance
Recognizing this MRI pattern may help clinicians consider hyperammonemic encephalopathy in septic patients with altered mental status, and the reversibility suggests a potentially favorable course with treatment.
Who should care
Limitations
Only 15 patients, descriptive, no control group and no stated clinical outcome beyond imaging and lab normalization, so specificity of the pattern is unknown.
Insular and cingulate cytotoxic-edema-type changes that reverse with treatment may be a characteristic imaging signature, pending larger controlled study.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Hyperammonemic encephalopathy (HE) is a severe complication of sepsis-induced liver injury (SILI), often associated with sepsis. However, its neuroimaging manifestations remain poorly understood. The aim of this pilot case series is to describe the brain MRI findings in patients with sepsis and HE.
METHODS
We analysed brain MRI data from 15 consecutive patients with sepsis and clinically confirmed HE. Assessment of cerebral changes was performed using a standard MRI protocol. The following parameters were evaluated during the analysis: localization and signal intensity characteristics of the lesions on MRI, presence or absence of diffusion restriction, presence magnetic susceptibility artifacts, and reversibility on follow‑up were evaluated descriptively. No control group was included.
RESULTS
Pathological changes were observed in all 15 patients. Symmetrical involvement of the insular cortex and cingulate gyrus was the most frequent pattern (13/15, 86.7%), followed by basal ganglia lesions (1/15) and cortico‑subcortical hemispheric lesions (1/15). All lesions were hyperintense on T2‑WI and FLAIR, with diffusion restriction on DWI suggestive of cytotoxic oedema. Follow-up MRI was performed in all patients after treatment adjustment and renal replacement therapy, demonstrating marked regression of all noted changes, concurrent with normalization of serum ammonia, transaminases, lactate and sepsis markers.
DOI
10.1007/s00234-026-04230-2
PMID
42891824
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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