Cirrhosis-related Parkinsonism: Prevalence, mechanisms and response to treatments

Encephalopathy in Wilson Disease: Copper Toxicity or Liver Failure?

“…This syndrome included Parkinsonism, ataxia, oro-facial dyskinesias (mimicking tardive dyskinesia with blepharosphasm, dystonia) and cognitive deficits occurring in patients with chronic liver disorders, especially with presence of portosystemic shunting. [46][47][48] AHD was unresponsive to ammonia-lowering therapy. 48 The pathogenesis of AHD is unknown, but shares many features commonly observed in HE (ie.…”

“…[46][47][48] AHD was unresponsive to ammonia-lowering therapy. 48 The pathogenesis of AHD is unknown, but shares many features commonly observed in HE (ie. manganese accumulation in basal ganglia).…”

“…manganese accumulation in basal ganglia). 47,48 However, most of the reported AHD patients were not tested with appropriate tests for WD. For example, in a case description from the Mayo clinic the authors argue that WD ".…”

Acquired hepatocerebral degeneration in a patient with hepatitis B and hepatitis delta virus coinfection

“…In a prospective study of 214 patients with liver cirrhosis who were eligible for liver transplantation, 9 demonstrated features of Parkinsonism 11 . Positron emission tomography scanning revealed significant reduction in the availability of the D2 dopamine receptor in 5 of the 9 patients studied and a significant reduction in the dopamine transporter in 3.…”

“…These data suggest that the alterations that damage presynaptic and striatal pro-synaptic neurotransmission could be the cause of Parkinsonism, explaining the limited effect of dopaminergic therapy. However, other mechanisms, such as genetic predisposition, could play a role in the increased deposition of manganese in the CNS of patients with cirrhosis, not only of those with Parkinsonism 8,11 . Our hypothesis is that, although not visualized on abdominal ultrasonography, our patient developed a portosystemic shunt.…”