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Acquired hepatocerebral degeneration

Case contributed by Vinay V Belaval
Diagnosis probable

Presentation

Known chronic liver parenchymal disease with recent altered sensorium.

Patient Data

Age: 70 years
Gender: Male

Axial and sagittal T1-weighted images show symmetrical hyperintense signals in bilateral globus pallidi, subthalamic nuclei and bilateral midbrain in the region of substantia nigra. No corresponding signal changes are evident on T2 and FLAIR images.

Gradient ECHO images show focal blooming in bilateral globus pallidi tips- representing focal mineralization.

Case Discussion

Patient with known chronic liver parenchymal disease presented with altered sensorium.

MRI brain showed symmetrical T1 hyperintense signals in bilateral globus pallidum, subthalamic nuclei and midbrain - most likely representing acquired hepatocerebral degeneration. The T1 hyperintense signals are thought to be due to manganese deposition. 

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