J Korean Neurol Assoc.  2005 Oct;23(5):621-626.

Clinical Features and Brain MRI Findings in Liver Cirrhosis-related Acute Metabolic Encephalopathy

• Cheon WH
• Kim SY
• Kweon YO
• Jung DK
• Park SP
• Suh CK

Abstract

BACKGROUND
Chronic liver disease is a common cause of metabolic neurologic deterioration. We analyzed the clinical features and MRI findings of patients with liver cirrhosis who showed rapidly progressing cerebral dysfunction. METHODS: From August 2001 to July 2003, we had 9 liver cirrhosis patients hospitalized due to acutely developed and rapidly progressed neurologic symptoms that were caused not by other metabolic disturbances. Blood tests and liver ultrasonography were performed to assess the severity of liver cirrhosis. A brain MRI study was done in all patients. RESULTS: The causes of liver cirrhosis were viral hepatitis (n=6), chronic alcoholism (n=2), and autoimmune disease (n=1). Serum ammonia and electrolyte levels were within the normal range. Truncal or limbs ataxia and dysarthria were the most common symptoms. The corpus callosum and dentate nucleus of the cerebellum were commonly involved on diffusion- and T2-weighted MRI. In spite of intensive investigation and treatment, all patients had a rapidly deteriorating course with the appearance of uncontrolled abnormal movements and a decreased consciousness level. Their deaths occured within 1 month of the onset of symptoms. CONCLUSIONS: We present nine liver cirrhosis patients with characteristic clinical features and diffusion- and T2-weighted MRI findings for the first time. It is assumed that some neurologic circuit plays a role in pathogenesis.

Keyword

Liver cirrhosis; Metabolic encephalopathy; Hepatocerebral degeneration; Magnetic resonance imaging

MeSH Terms

Alcoholism
Ammonia
Ataxia
Autoimmune Diseases
Brain Diseases, Metabolic*
Brain*
Cerebellar Nuclei
Cerebellum
Consciousness
Corpus Callosum
Dysarthria
Dyskinesias
Extremities
Hematologic Tests
Hepatitis
Hepatolenticular Degeneration
Humans
Liver Cirrhosis
Liver Diseases
Liver*
Magnetic Resonance Imaging*
Neurologic Manifestations
Reference Values
Ultrasonography
Ammonia