Hepatic encephalopathy with corticospinal tract involvement demonstrated by diffusion tensor tractography

Annals of Rehabilitation Medicine
Hyun BangJongmin Lee

Abstract

A 50-year-old man with liver cirrhosis and esophageal varix for 3 years was diagnosed with hematemesis and treated for a bleeding varix. However, bleeding recurred 11 days later, and he developed drowsiness with left hemiparesis. His left upper and lower extremity muscle strengths based on the manual muscle test at the onset were grade 2/5 and 1/5, respectively. The Babinski sign was positive. His serum ammonia level was elevated to 129.9 µg/dL (normal, 20-80 µg/dL). Magnetic resonance imaging revealed restriction on diffusion and T2-hyperintensities with decreased apparent diffusion coefficient values in the bilateral frontoparietooccipital cortex. The effect was more severe in the right hemisphere and right parietooccipital cortices, which were compatible with hepatic encephalopathy. Although the patient's mental status recovered, significant left-sided weakness and sensory deficit persisted even after 6 months. Diffusion tensor tractography (DTT) performed 3 months post-onset showed decreased volume of the right corticospinal tract. We reported a patient with hepatic encephalopathy involving the corticospinal tract by DTT.

References

Apr 1, 1992·American Journal of Physical Medicine & Rehabilitation·J W AtchisonV Matkovic
May 11, 2005·World Journal of Gastroenterology : WJG·Sergei MechtcheriakovJosef Marksteiner
Nov 5, 2005·World Journal of Gastroenterology : WJG·Sergei MechtcheriakovWolfgang Vogel
Mar 25, 2006·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ravindra A KalePonnada A Narayana
Jul 17, 2010·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Yoshiya YamamotoYasuo Katayama
Aug 13, 2010·Nature Reviews. Gastroenterology & Hepatology·Ravi Prakash, Kevin D Mullen
Dec 15, 2010·Journal of Hepatology·Juan Córdoba

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