Hepatic failure and encephalopathy with hyperammonemia and hyperbilirubinemia. There are large areas of restricted diffusion and faint T2 hyperintensity, predominantly in a cortical and subcortical distribution involving the right posterior and medial temporal, anterior occipital, and parietal lobes, as well as the left temporal lobe and insula. There also appears to be mildly restricted diffusion in the bilateral posterior thalami. There are scattered areas of deep and periventricular white matter T2 hyperintensity without corresponding restricted diffusion. The brainstem and cerebellum are unremarkable. There is suggestion of a punctate lesion in the roof of the third ventricle that corresponds to the hyperattenuating lesion demonstrated on CT. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.
1. Extensive scattered areas of restricted diffusion in the periphery of the bilateral cerebral hemispheres likely represents acute hepatic encephalopathy.2. Background of mild chronic white matter ischemic disease.3. A probable tiny colloid cyst of the third ventricle is more conspicuous on the prior CT.