Hepatic Encephalopathy (HE) is believed to arise from high levels of ammonia circulating in the blood stream, occurring during acute or chronic liver disease, often as a consequence of alcoholism. Altered ammonia levels in the body directly influence brain metabolism and can lead to glial swelling and neuronal cell death (Kundra, Jain, Banga, Bajaj, & Kar, 2005; Rama Rao & Norenberg, 2014). HE patients may appear confused, disoriented, and have poor coordination (Prakash & Mullen, 2010; Vaquero, Chung, Cahill, & Blei, 2003). MRI images show bilateral, symmetrical high-intensity signals in the basal ganglia, prominent in globus pallidus, and substantia nigra (Figure 1C) (Binesh et al., 2006; Cordoba, Sanpedro, Alonso, & Rovira, 2002; Naegele et al., 2000), as well as along the cortico-spinal tract and white-matter of the cerebral hemispheres (Rovira et al., 2002).
