title: Persistence of mild parkinsonism 4 months after liver transplantation in patients with preoperative minimal hepatic encephalopathy: a study on neuroradiological and blood manganese changes.
abstract: Pallidal hyperintensity at magnetic resonance imaging (MRI) correlates to blood manganese (Mn) levels and parkinsonian signs in patients with cirrhosis. Similarly, metabolite changes in the basal ganglia (BG) at proton spectroscopy are related to these neurological signs. The evolution of these abnormalities after liver transplantation (OLT) is incompletely described. We evaluated 14 unselected consecutive patients with cirrhosis (minimal hepatic encephalopathy [HE] n=8, no HE n=6) before and 4 months after successful OLT for the evolution of parkinsonism using a validated scale (the United Parkinson's Disease Rating Scale, or UPDRS). Pallidal intensity at MRI, spectroscopic changes in the BG at magnetic resonance spectroscopy (MRS), and whole blood manganese concentrations were measured. After OLT in patients with preoperative minimal HE, the UPDRS scores improved, but mild parkinsonism persisted (16.1+/-3.6 to 6.2+/-4.8, P<0.05). Pallidal hyperintensity remained abnormal in 5/8 of cases, but spectroscopic changes normalized in all patients. Blood Mn remained elevated in 4/6 patients. In patients without HE, UPDRS values remained negligible (2.42+/-1.5 to 2.5+/-1.4). Pallidal hyperintensity normalized in 7/8 patients and spectroscopic changes normalized in all patients. Blood Mn remained elevated in 5/6 patients. Four months after successful OLT, patients with preoperative minimal HE and severe pallidal hyperintensity showed persistent mild parkinsonism. The role of blood manganese determination appears limited in the monitoring of MRI and parkinsonian signs changes after OLT.
authors.affiliation: Radiology Department, University Hospital, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Lazeyras
authors.forename: Laurent
authors.initials: L
authors.lastname: Spahr
authors.forename: Renaud
authors.initials: R
authors.lastname: DuPasquier
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Delavelle
authors.forename: Pierre
authors.initials: P
authors.lastname: Burkhard
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
authors.forename: Denis
authors.initials: D
authors.lastname: Hochstrasser
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Emile
authors.initials: E
authors.lastname: Giostra
authors.forename: François
authors.initials: F
authors.lastname: Terrier
authors.forename: François
authors.initials: F
authors.lastname: Vingerhoets
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000097:blood*; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000503:physiopathology*; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies
chemical_list: D008345:Manganese