Female, 59 years old, with altered mental status and tremors, history of liver cirrhosis due to autoimmune hepatitis, history of hepatic encephalopathy. Brain:Patchy T2 hyperintensity without mass effect is seen affecting the globus pallidus nuclei symmetrically and bilaterally. The deep gray nuclei are otherwise unremarkable.At most, there may be one or two scattered small foci of nonspecific parenchymal T2 hyperintensity. No restricted diffusion, edema or mass effect is observed. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.Mucosal thickening and secretions are evident in the maxillary sinuses. The bone marrow signal characteristics are within normal limits.C-spine:There is a mild levocurvature of the cervical spine but this may be positional. Spinal alignment is otherwise within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. Within the limitations of motion artifact, the visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected. C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.
1.Abnormal signal intensity is seen in the globus pallidus nuclei bilaterally and symmetrically. This finding carries a long differential diagnosis including ischemic, toxic and metabolic processes. However, it can also be seen in the context of chronic hepatic dysfunction, and given the patient's history, this would be favored as the underlying etiology.2.The remainder of the brain is unremarkable with no additional acute or specific findings.3.Mild degenerative disc disease is seen in the cervical spine without significant spinal canal compromise. No abnormalities of the spinal cord are suspected.