Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a neuropsychiatric spectrum mainly caused by cirrhosis, portosystemic shunt, or portal hypertension. It may also mimic the presentation of Parkinson’s disease, which can make clinical diagnosis a challenge. A 42-year-old man with underlying chronic hepatitis C with liv...
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my.ums.eprints.392722024-07-26T02:47:11Z https://eprints.ums.edu.my/id/eprint/39272/ Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy Mohamad Shahrunizam Awang Setia Mohamad Izzat Arslan Che Ros Nurul Hafidzah Rahim Nik Azuan Nik Ismail RC346-429 Neurology. Diseases of the nervous system Including speech disorders RC799-869 Diseases of the digestive system. Gastroenterology Hepatic encephalopathy (HE) is a neuropsychiatric spectrum mainly caused by cirrhosis, portosystemic shunt, or portal hypertension. It may also mimic the presentation of Parkinson’s disease, which can make clinical diagnosis a challenge. A 42-year-old man with underlying chronic hepatitis C with liver cirrhosis was initially admitted for chronic lower back pain. During admission, he appeared drowsy but was able to answer questions appropriately albeit with delayed and slow speech. He had bradykinesia without stigmata of chronic liver disease. Differentials at the time were hypoactive delirium and Parkinson’s disease. Blood results were normal. Magnetic resonance imaging (MRI) of the brain showed bilateral symmetrical hyperintensities at the inferior temporal lobes, medial thalamus, cingulate gyri, head of caudate nuclei, posterior limbs of internal capsules and insula on fluid-attenuated inversion recovery (FLAIR) sequence. On the T1 weighted imaging (T1WI) sequence, bilateral symmetrical hyperintensities were seen at globus pallidi, cerebral peduncles and periaqueductal regions extending to superior cerebellar peduncles. Based on imaging, a diagnosis of acute chronic hepatic encephalopathy was made. The patient was treated conservatively in the ward and was discharged with persistent Parkinsonism. In patients with neurological abnormalities where hepatic encephalopathy (HE) is least expected due to subtle symptoms, MRI could play an important role in eliciting the underlying cause, and extent of disease and for prognostication. Penerbit UMS 2023 Article NonPeerReviewed text en https://eprints.ums.edu.my/id/eprint/39272/1/ABSTRACT.pdf text en https://eprints.ums.edu.my/id/eprint/39272/2/FULL%20TEXT.pdf Mohamad Shahrunizam Awang Setia and Mohamad Izzat Arslan Che Ros and Nurul Hafidzah Rahim and Nik Azuan Nik Ismail (2023) Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy. Borneo Journal of Medical Sciences, 17. pp. 48-52. ISSN 1985-1758 https://doi.org/10.51200/bjms.v17i3.4257 |
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RC346-429 Neurology. Diseases of the nervous system Including speech disorders RC799-869 Diseases of the digestive system. Gastroenterology Mohamad Shahrunizam Awang Setia Mohamad Izzat Arslan Che Ros Nurul Hafidzah Rahim Nik Azuan Nik Ismail Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy |
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Hepatic encephalopathy (HE) is a neuropsychiatric spectrum mainly caused by cirrhosis, portosystemic shunt, or portal hypertension. It may also mimic the presentation of Parkinson’s disease, which can make clinical diagnosis a challenge. A 42-year-old man with underlying chronic hepatitis C with liver cirrhosis was initially admitted for chronic lower back pain. During admission, he appeared drowsy but was able to answer questions appropriately albeit with delayed and slow speech. He had bradykinesia without stigmata of chronic liver disease. Differentials at the time were hypoactive delirium and Parkinson’s disease. Blood results were normal. Magnetic resonance imaging (MRI) of the brain showed bilateral symmetrical hyperintensities at the inferior temporal lobes, medial thalamus, cingulate gyri, head of caudate nuclei, posterior limbs of internal capsules and insula on fluid-attenuated inversion recovery (FLAIR) sequence. On the T1 weighted imaging (T1WI) sequence, bilateral symmetrical hyperintensities were seen at globus pallidi, cerebral peduncles and periaqueductal regions extending to superior cerebellar peduncles. Based on imaging, a diagnosis of acute chronic hepatic encephalopathy was made. The patient was treated conservatively in the ward and was discharged with persistent Parkinsonism. In patients with neurological abnormalities where hepatic encephalopathy (HE) is least expected due to subtle symptoms, MRI could play an important role in eliciting the underlying cause, and extent of disease and for prognostication. |
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Article |
author |
Mohamad Shahrunizam Awang Setia Mohamad Izzat Arslan Che Ros Nurul Hafidzah Rahim Nik Azuan Nik Ismail |
author_facet |
Mohamad Shahrunizam Awang Setia Mohamad Izzat Arslan Che Ros Nurul Hafidzah Rahim Nik Azuan Nik Ismail |
author_sort |
Mohamad Shahrunizam Awang Setia |
title |
Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy |
title_short |
Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy |
title_full |
Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy |
title_fullStr |
Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy |
title_full_unstemmed |
Parkinson’s mimicker in Acute and Chronic Hepatic Encephalopathy |
title_sort |
parkinson’s mimicker in acute and chronic hepatic encephalopathy |
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Penerbit UMS |
publishDate |
2023 |
url |
https://eprints.ums.edu.my/id/eprint/39272/1/ABSTRACT.pdf https://eprints.ums.edu.my/id/eprint/39272/2/FULL%20TEXT.pdf https://eprints.ums.edu.my/id/eprint/39272/ https://doi.org/10.51200/bjms.v17i3.4257 |
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13.188404 |