Comparison of MR Findings and Clinical Features according to Underlying Disease in Metabolic Encephalopathy

ABSTRACT

PURPOSE: Metabolic encephalopathy is not an infrequent condition. However it is very difficult to diagnose and treat because of its various causes and clinical manifestations. Our purpose was to clarify the cause of metabolic encephalopathy by evaluation of MR findings and clinical features. METHODS: We reviewed MR images and clinical features for 25 patients with metabolic encephalopathy who showed abnormal signal changes on the MR images with neurologic deterioration. RESULTS: The 25 patients had underlying diseases such as chronic liver disease (n=16) or renal failure (n=9). The MR findings showed significant differences in the involved sites according to the underlying disease. In 10 of the 16 patients with liver disease, corpus callosal involvement was observed. Red nucleus involvement was seen in 6 patients, dentate nucleus involvement in 5 patients. These lesions were seen to have a high signal intensity on the diffusion weighted image. Contrary to liver disease, encephalopathy with renal disease showed typical central pontine myelinolysis in 6 of the 9 patients and a relatively benign clinical course. CONCLUSION: Our results showed that the typically involved site and clinical manifestations depended on the underlying disease. We think that involvement of the corpus callosum, the red nucleus, and the dentate nucleus is a typical pattern of injury in metabolic encephalopathy with chronic liver disease and that these findings will be helpful for diagnosing and treating metabolic encephalopathy.