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

J Korean Neurol Assoc > Volume 23(5); 2005 > Article

Journal of the Korean Neurological Association 2005;23(5): 621-626.

간경변에 의한 급성 대사성 뇌병증의 임상 양상 및 두부 자기공명영상 소견

전우현, 김선영 권영오a 정두교 박성파 서정규

경북대학교 의과대학 신경과학교실, 경북대학교 의과대학 내과학교실

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

Woo-Hyun Cheon

Department of Neurology, Kyungpook National University School of Medicine, Daegu; Department of Internal Medicine, Kyungpook National University School of Medicinea, Daegu, Korea

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. KeyWords:Liver cirrhosis, Metabolic encephalopathy, Hepatocerebral degeneration, Magnetic resonance imaging