Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism

Figure 1 Electroencephalograph and magnetic resonance findings at baseline and after treatment with thyroid hormone. A: EEG at baseline showing slow activity and generalized triphasic waves; B: EEG after treatment showing normalization of brain activity; C: T1-weighted MRI showed high-signal in basal ganglia at baseline; D: T1-weighted MRI performed after thyroid hormone replacement showed non-significant changes; E: FLAIR MRI sequence at baseline demonstrated subtle periventricular white matter hyperintensities; F: FLAIR MRI image after thyroid hormone replacement demonstrated a normalization of periventricular white matter signal abnormalities. EEG: Electroencephalograph; MRI: Magnetic resonance imaging.