A case of atypical hepatic encephalopathy showing mainly extrapyramidal symptoms.
- Author:
Dong Keun LEE
1
;
Byung Ho KIM
;
Seok Ho DONG
;
Hyo Jong KIM
;
Young Woon CHANG
;
Joung Il LEE
;
Rin CHANG
;
Kyung Cheon JEONG
Author Information
1. Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea. dklee23@hanmail.net
- Publication Type:Case Report
- Keywords:
Hepatitis B;
Chronic;
Hepatitis viruses;
DNA;
Lamivudine
- MeSH:
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
- From:Korean Journal of Medicine
2000;59(1):95-99
- CountryRepublic of Korea
- Language:Korean
-
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.
