title: Unilateral basal-ganglia involvement likely due to valproate-induced hyperammonemic encephalopathy.
abstract: A male child suffering from generalized tonic clonic epilepsy, on treatment with valproate, developed fulminant hepatic failure, hyperammonemia and encephalopathy due to drug toxicity. The most extraordinary feature was his MRI (FLAIR image) of brain which showed unilateral hyperintensities in right putamen and caudate nucleus. The patient recovered on withdrawal of valproate with mild residual left sided athetotic movements during remission. Repeat investigation confirmed an improved MRI imaging and normalised blood ammonia levels. The case report is unique because of unilateral involvement of basal ganglia due to valproate-induced encephalopathy.
authors.affiliation: Department of Pediatrics, Medical College Kolkata, Kolkata, India. swarnalijoardar@gmail.com
authors.forename: Swarnali
authors.initials: S
authors.lastname: Joardar
authors.forename: Shubhadeep
authors.initials: S
authors.lastname: Das
authors.forename: Rita
authors.initials: R
authors.lastname: Chatterjee
authors.forename: Gautam
authors.initials: G
authors.lastname: Guha
authors.forename: M A
authors.initials: MA
authors.lastname: Hasmi
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects; D001479:Basal Ganglia / Q000473:pathology*; D001927:Brain Diseases / Q000139:chemically induced / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D007839:Functional Laterality; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced / Q000150:complications / Q000473:pathology*; D019344:Lactic Acid / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012640:Seizures / Q000188:drug therapy; D014635:Valproic Acid / Q000009:adverse effects
chemical_list: D000927:Anticonvulsants; D019344:Lactic Acid; D014635:Valproic Acid
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