Acquired hepatocerebral degeneration

Case contributed by Dr Varun Babu

Presentation

Decreased attention with parkinsonism features.

Patient Data

Age: 70-year-old
Gender: Male

MRI Brain

Modality: MRI

Symmetric T1 hyperintense signals are seen arising from both globus pallid, ventrolateral thalami and substantia nigra of the midbrain. There is sparing of cerebellum, red nucleus and putamen. No features of midbrain atrophy. Age proportionate cerebral atrophic changes. 

CT chest with upper abdomen cuts

Modality: CT

Cirrhotic liver identified in upper abdominal slices. 

Case Discussion

Following detection of the symmetric T1 hyperintense affliction of globus pallidus, ventrolateral thalami and substantia nigra, a possibility of hepatocerebral degeneration was considered. Previous imaging of the patient was reviewed. A CT chest study done a month ago revealed the cirrhotic nature of liver. 

Acquired hepatocerebral degeneration is an often underdiagnosed condition which can present with parkinsonism features. This also highlights the importance of not ignoring the T1 weighted image of brain, which by convention has always been a source of 'anatomical' information. One of those rare instances when pathology is only identified in this sequence.

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Case Information

rID: 41822
Case created: 21st Dec 2015
Last edited: 19th Feb 2016
Inclusion in quiz mode: Included

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