Neurol Sci (2017) 38:1547–1549 DOI 10.1007/s10072-017-2976-8 LETTER TO THE EDITOR Parkinsonism and high-intensity midbrain lesions on T2-weighted imaging in hepatic encephalopathy: a case report 1 1 1 1 Nobuyuki Ishii & Hitoshi Mochizuki & Katsuya Sakai & Kazutaka Shiomi & Masamitsu Nakazato Received: 10 December 2016 /Accepted: 19 April 2017 /Published online: 27 April 2017 Springer-Verlag Italia 2017 Dear Sir, On admission, her vital signs were normal except for slight- Hepatic encephalopathy (HE) is caused by cirrhosis and/or ly decreased consciousness. On physical examination, she did portosystemic shunting, and its clinical manifestations include not have jaundice and her liver was not palpable. Findings on not only fluctuations in consciousness levels but also neuro- neurological examination included asterixis and various extra- pyramidal signs, as follows: intact voice and facial expression; logical symptoms such as parkinsonism and cerebellar ataxia, which are usually decreased by ammonia-lowering therapy no resting tremor; lead-pipe rigidity of the neck and bilateral . In patients with cirrhosis severe enough to cause HE, brain limbs; bilateral slow finger tapping; slow walking with a magnetic resonance imaging (MRI) usually shows T1 forward-flexed posture and small steps but intact arm swings; hyperintensity in the bilateral basal ganglia; this is the
Neurological Sciences – Springer Journals
Published: Apr 27, 2017
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