Neuropsychiatric symptoms as the presenting feature of acquired hepatocerebral degeneration

Recent Updates on Acquired Hepatocerebral Degeneration

BACKGROUND

Acquired hepatocerebral degeneration (AHD) refers to a chronic neurological syndrome in patients with advanced hepatobiliary diseases. This comprehensive review focuses on the pathomechanism and neuroimaging findings in AHD.

METHODS

A PubMed search was performed using the terms "acquired hepatocerebral degeneration," "chronic hepatocerebral degeneration," "Non-Wilsonian hepatocerebral degeneration," "cirrhosis-related parkinsonism," and "manganese and liver disease."

RESULTS

Multiple mechanisms involving the accumulation of toxic substances such as ammonia or manganese and neuroinflammation may lead to widespread neurodegeneration in AHD. Clinical characteristics include movement disorders, mainly parkinsonism and ataxia-plus syndrome, as well as cognitive impairment with psychiatric features. Neuroimaging studies of AHD with parkinsonism show hyperintensity in the bilateral globus pallidus on T1-weighted magnetic resonance images, whereas molecular imaging of the presynaptic dopaminergic system shows variable findings. Ataxia-plus syndrome in AHD may demonstrate high-signal lesions in the middle cerebellar peduncles on T2-weighted images.

DISCUSSION

Future studies are needed to elucidate the exact pathomechanism and neuroimaging findings of this heterogeneous syndrome.

Acquired hepatocerebral degeneration

Acquired hepatocerebral degeneration is a rare, mostly irreversible neurological syndrome that occurs in patients with chronic liver disease, particularly in those with surgically or spontaneously induced portosystemic shunts. Typical magnetic resonance findings are T1 hyperintensity in the pallidum, substantia nigra, periaquaductal gray matter. In this paper, we report a case of a 51-year-old woman presented with hepatic encephalopathy episodes and typical magnetic resonance findings, who does not develop any neurological signs or symptoms, nor cognitive decline in the follow up period, lasting for 3 years.