Brain MRI Patterns in Acute Intermittent Porphyria: A Broader Spectrum Than PRES

Acute intermittent porphyria brain MRI shows a spectrum beyond PRES: lobar-cortical pattern (32%), hippocampal (21%), and 25% normal. Dysautonomia (44% of episodes) was associated with ileus (p<0.001) and hyponatremia (p=0.02).

• Retrospective study of 27 acute neurovisceral episodes in 23 patients with biochemically confirmed AIP.
• Lobar-cortical pattern most frequent (32.1%); no single pattern was diagnostic; two patients had evolving serial MRI findings.
• Dysautonomia (44.4% of episodes) significantly linked to ileus (p<0.001) and hyponatremia (p=0.02), suggesting a shared autonomic basis.

Retrospective, single-center design without a control group limits generalizability.

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