Korean J Med.  2000 Jul;59(1):95-99.

A case of atypical hepatic encephalopathy showing mainly extrapyramidal symptoms

• Lee DK
• Kim BH
• Dong SH
• Kim HJ
• Chang YW
• Lee JI
• Chang R
• Jeong KC

Abstract

Hepatic encephalopathy is a complex neuropsychiatric syndrome with protean clinical manifestations. Recently, we experienced a atypical case of hepatic encephalopathy who chiefly complained of extrapyramidal symptoms. A 41-year-old female had a 4-year history of liver cirrhosis that was caused by hepatitis B virus. Three days before admission, she began to feel resting hand tremor, facial diplegia, dysarthria, drooling and swallowing difficulty. On physical examination, cogwheel rigidity of upper extremities, stooping posture and loss of arm swing on walk were noted, but all sensory functions were intact. MRI showed abnormally increased signal on T1-weighted images in the corpus striatum, mainly in the putamen and globus pallidus, and the head of the caudate nucleus. Her neurological and radiological findings were consistent with manganese intoxication, but she had no history of manganese exposure. The extrapyramidal symptoms and signs were successfully controlled after the administration of anti-parkinsonian drugs, but it was uncertain whether this improvement was a result of drug therapy or not.

Keyword

Hepatitis B; Chronic; Hepatitis viruses; DNA; Lamivudine

MeSH Terms

Adult
Arm
Caudate Nucleus
Corpus Striatum
Deglutition
DNA
Drug Therapy
Dysarthria
Female
Globus Pallidus
Hand
Head
Hepatic Encephalopathy*
Hepatitis B
Hepatitis B virus
Hepatitis Viruses
Humans
Lamivudine
Liver Cirrhosis
Magnetic Resonance Imaging
Manganese
Muscle Rigidity
Physical Examination
Posture
Putamen
Sensation
Sialorrhea
Tremor
Upper Extremity
DNA
Lamivudine
Manganese