Abstract
A 73-year-old woman presented with a 3-day history of bizarre behavior. She had no history of psychological, neurologic, or liver disease. Examination revealed cognitive impairment. Laboratory tests revealed unexplained hyperammonemia (176 μg/dL). The cerebrospinal fluid findings were normal. Magnetic resonance imaging revealed T1 hyperintensity in the globus pallidus (Figure A, arrowheads). Enhanced computed tomography demonstrated a portosystemic venous shunt (Figures B, arrowheads and C, arrow).
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