Acquired hepatocerebral degeneration: clinical characteristics and MRI findings
Article first published online: 28 JUN 2010
© 2010 The Author(s). European Journal of Neurology © 2010 EFNS
European Journal of Neurology
Volume 17, Issue 12, pages 1463–1470, December 2010
How to Cite
Fernández-Rodriguez, R., Contreras, A., De Villoria, J. G. and Grandas, F. (2010), Acquired hepatocerebral degeneration: clinical characteristics and MRI findings. European Journal of Neurology, 17: 1463–1470. doi: 10.1111/j.1468-1331.2010.03076.x
- Issue published online: 18 NOV 2010
- Article first published online: 28 JUN 2010
- Received 3 September 2009 Accepted 29 March 2010
- acquired hepatocerebral degeneration;
- globus pallidus;
- liver transplantation;
- MRI hyperintensities;
- portosystemic shunts
Objective: To determine the prevalence of acquired hepatocerebral degeneration (AHD), its clinical and neuroimaging characteristics and response to treatments.
Background: Acquired hepatocerebral degeneration is a chronic encephalopathy with predominant motor signs in the context of severe liver disease. Its clinical picture is not well defined, and its prevalence and risk factors are not well known.
Methods: Review of a database of 1000 patients with cirrhosis to identify cases of AHD. Clinical and neuroimaging data, follow-up and response to treatments, including liver transplantation, were recorded.
Results: Eight patients with AHD were identified. Its prevalence was 0.8% of patients with cirrhosis. The main risk factor for AHD was the presence of portosystemic shunts. Movement disorders, especially a combination of parkinsonism and cerebellar signs were observed in all patients. All AHD cases showed on MRI T1-weighted images hyperintensities in the globus pallidus, and 75% had extrapallidal involvement as well. Antiparkisonian drugs and treatments to prevent acute encephalopathies were ineffective. Three patients who underwent liver transplantation did not experience neurological improvement. Persistence of portosystemic shunts was demonstrated in two cases.
Conclusions: Acquired hepatocerebral degeneration is a chronic encephalopathy which occurs in ∼1% of patients with liver cirrhosis and seems related to portosystemic shunts. Its is characterized by a combination of parkinsonism and cerebellar signs. MRI pallidal and extrapallidal lesions are seen in most patients, probably reflecting intracerebral deposits of manganese. Liver transplant did not improve the neurological signs in our patients, perhaps because of the persistence of portosystemic shunts.