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Portal systemic encephalopathy presenting with dressing and constructional apraxia.
T Kanda1, S Nogawa, K Muramatsu
1Department of Neurology, Keio University, Tokyo.
Internal Medicine (Tokyo, Japan)
|June 1, 2000
Summary
Portal systemic encephalopathy can cause neurological deficits like apraxia and weakness. This case highlights intrahepatic shunting and hyperammonemia as key indicators, impacting cerebral blood flow in specific brain regions.
Area of Science:
- Neurology
- Hepatology
- Radiology
Background:
- Portal systemic encephalopathy (PSE) is a neuropsychiatric complication of liver dysfunction.
- Patients may present with diverse neurological symptoms, often mimicking other conditions.
Observation:
- A patient presented with dressing and constructional apraxia and left-hand weakness, initially suspected as a stroke.
- Brain imaging revealed basal ganglia hyperintensities, and blood tests confirmed hyperammonemia.
Findings:
- Magnetic resonance angiography identified an intrahepatic portal systemic shunt.
- Xenon-enhanced computed tomography showed reduced cerebral blood flow, particularly in the right parietal watershed regions.
Implications:
- This case underscores the importance of considering PSE in patients with unexplained neurological deficits and hyperammonemia.
- Findings suggest watershed areas are vulnerable to toxic metabolites in hepatic encephalopathy, potentially due to altered cerebral perfusion.