Fig 3.

Patient 2. A 48-year-old man with fulminant acute hepatic failure due to acetaminophen overdose with a background of chronic alcohol abuse, His ICU stay was complicated by sepsis due to pneumonia and Clostridium difficile diarrhea. On day 8 post−ICU admission, he deteriorated neurologically with a decreased level of consciousness, abnormal posturing, and seizures. DWI (A and B) and T2-weighted images (C and D) show symmetric abnormal high signal intensity in the insular and cingulate cortices (open arrows). High signal intensity is also seen involving the cortex of the temporoparietal lobes bilaterally, bilateral thalami (arrowheads), and brain stem (closed arrow). His plasma ammonium level was 102 μmol/L. The patient's condition deteriorated further, and he died the next day without repeat imaging.