Intrahepatic portal-hepatic venous anastomosis: a portal-systemic shunt with neurological repercussions.
Intrahepatic shunts are rarely diagnosed as a cause of neurocognitive abnormality. A complaint of fatigue led to the diagnosis of a right portal vein-hepatic vein aneurysmal communication in a 23-yr-old, otherwise healthy woman. Neuropsychological testing, imaging, and MR spectroscopy revealed changes similar to those described in patients with cirrhosis and subclinical hepatic encephalopathy. T1-weighted MRI showed a hyperintense globus pallidus, a feature seen in subjects with and without portal-encephalopathy. Portal-systemic shunting in the absence of parenchymal liver disease reproduces neurological features described in cirrhosis.
Crespin
J
J
Department of Medicine, Northwestern Memorial Hospital and Northwestern University, Chicago, Illinois 60611, USA.
Nemcek
A
A
Rehkemper
G
G
Blei
A T
AT
D000328:Adult; D005260:Female; D005917:Globus Pallidus / Q000473:pathology; D006503:Hepatic Veins / Q000002:abnormalities*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D011169:Portal Vein / Q000002:abnormalities*; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000150:complications* / Q000000981:diagnostic imaging