Recovery from parkinson syndrome and prolonged visually evoked potentials in hepatic encephalopathy.
The combination of Parkinson syndrome (PS) and prolonged visually evoked potentials (VEPs) in a single patient with hepatic encephalopathy (HE) has not been reported. A 52-year-old male with chronic HE developed PS in early 2001. Treatment with L-DOPA was only of minimal effect. In August 2001 he was admitted because of worsening PS and HE. There was anemia, hyperlipidaemia, markedly elevated liver-function-parameters, hyperammonemia, elevated resting-lactate, steatosis hepatis and hepatomegalia. VEPs showed markedly prolonged P100-latencies. Under L-DOPA, pramipexol, L-ornithin-L-aspartate, paromomycin-sulfate, and lactulose liver-function-parameters normalized and PS markedly improved. In February 2003, VEPs were normal. L-DOPA was discontinued by the patient in April 2003 and pramipexol in December 2003. Since then PS did not recur. This case shows that HE may go along with reversible PS and prolonged VEPs. Under adequate therapy liver-function-parameters and VEPs normalize and PS disappears.
Finsterer
Josef
J
Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria. duarte@aonmail.at
Bernauer
Elisabeth
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000627:therapeutic use; D052160:Benzothiazoles; D001921:Brain / Q000378:metabolism / Q000503:physiopathology*; D002908:Chronic Disease; D004151:Dipeptides / Q000627:therapeutic use; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D010303:Paromomycin / Q000627:therapeutic use; D000077487:Pramipexole; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D000978:Antiparkinson Agents; D052160:Benzothiazoles; D004151:Dipeptides; D005765:Gastrointestinal Agents; D013844:Thiazoles; D007792:Lactulose; D007980:Levodopa; D010303:Paromomycin; D000077487:Pramipexole; C002939:ornithylaspartate