Gastro-intestinal Stromal Tumor (GIST) Encephalopathy

A 52 year old gentleman presented in emergency department with drowsiness, altered sensorium and confusion. Magnetic resonance imaging of brain and cerebro-spinal fluid examination were within normal limits. Routine blood investigations were normal. As the patient started worsening symptomatically, reflex investigations revealed hyperammonemia. Patient had undergone surgery for duodenal gastrointestinal stromal tumor (GIST) in the past. Current abdominal imaging revealed unresectable recurrence of tumor. Patient was started on imatinib with which he improved symptomatically and biochemically. Hence a diagnosis of ‘GIST secreting hyperammonemic encephalopathy’ was made.