Figure 4. a, b.

A 22-year-old male with encephalopathy. ER providers requested an LP. However, head CT demonstrated slit-like ventricles with diffuse swelling of the entire brain (a) and cerebellar herniation (b). The LP request was declined by the radiologist after evaluation of the CT. At follow-up, the patient was found to have acute liver failure with hepatic encephalopathy.