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Laboratory studies CBC: normal or nonspecific findings BMP: possible Na + , Cr Liver chemistries: AST and ALT Imaging: frequently performed in acute attacks to rule out differential diagnoses Abdominal imaging (x-ray or CT): Typically normal May show dilated bowel loops with air-fluid levels representing an ileus MRI or CT brain Typically normal May show white matter vasogenic edema affecting the posterior brain, consistent with posterior reversible encephalopathy syndrome (PRES) [9] Confirmatory studies First-line testing: spot urine sample for heme precursor levels Porphobilinogen (PBG): ( 20200 mg/L) -aminolevulinic acid (ALA): ( 10100 mg/L) Second-line testing Porphyrin levels: greatly increased in urine, normal to slightly increased in feces and plasma Erythrocyte porphobilinogen: decreased Enzyme activity measurement and DNA testing A 24-hour urine collection is not necessary for the diagnosis of an acute AIP attack and delays diagnosis

The remaining fat particles were digested with 0.2% collagenase (Gibco, Billings, MT, USA) in a water bath shaker at 37 C for 30 min, and the mixture was centrifuged at 1000 rpm for 5 min to remove undigested fat

Increased levels of GAD enzymes and GAD67-positive neurons have been observed in the ipsilateral striatum 1 to 2 days after transient forebrain ischemia (Li et al., 2010)

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