【One case per day 422 stage】Chronic hepatic encephalopathy

The patient, a 54-year-old male, has hepatitis C with onset symptoms of tremor and mental abnormalities

Based on the above information, please discuss: What is the most likely diagnosis of this patient?

The answer is revealed

【Diagnosis】

Chronic hepatic encephalopathy

【Image Performance】

MRI of the skull shows T1WI in axial and sagittal positions, and the patient has elevated bilateral Globus pallidus T1

【Diagnostic Points】

In patients with chronic hepatic encephalopathy, bilateral basal ganglion T1WI high signal, especially in bilateral globulus pallidus;

T1WI high signal can also occur in the substantia nigra;

The incidence of the above abnormal manifestations in patients with chronic liver failure is about 80% to 90%;

It is currently agreed that it is caused by

This MRI presentation is reversible

【Clinical signs and symptoms】

Mental abnormalities leading to stiffness or coma;

Cognitive difficulties;

Abnormalities of motor neurons, including tremor, bradykinesia, Parkinson's syndrome, atylopirosis;

Other physical findings: erythema

【Differential diagnosis】

Wilson's disease: basal ganglion and/or bilateral thalamic symmetrical T1WI hypersignal

Neurofibromatosis type I: an autosomal dominant disease with multiple imaging manifestations

Patients with intravenous fluids: excessive intrahepatic manganese deposition in patients with intravenous fluids associated with TPN, causing liver failure

Welder occupational disease patients: inhalation of too much manganese elements causes it to accumulate in the liver, causing liver failure

Ischemic hypoxic encephalopathy: basal ganglion T1/T2 hypersignal