Reversible Parkinsonism and T1W pallidal hyperintensities in acute liver failure.
We report on a young woman who survived acute liver failure (ALF) without liver transplant. During the ALF, she developed a disabling, levodopa-unresponsive, symmetrical Parkinsonism. This was characterized by severe bradykinesia, mild rigidity, mutism, and prominent gait impairment. Magnetic resonance imaging (MRI) showed bilateral T1W pallidal hyperintensities. Parkinsonism and MRI changes remitted in parallel with normalization of hepatic function. We implicate excessive pallidal manganese deposition secondary to ALF in the pathogenesis of this neuroradiological syndrome. Though hitherto unreported, we propose that Parkinsonism with T1W pallidal hyperintensities may not be uncommon in ALF.
Aggarwal
Annu
A
Movement Disorder Clinic, Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India.
Vaidya
Sachin
S
Shah
Samir
S
Singh
Joshita
J
Desai
Shrinivas
S
Bhatt
Mohit
M
D000328:Adult; D000978:Antiparkinson Agents / Q000009:adverse effects; D005260:Female; D005917:Globus Pallidus / Q000473:pathology*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D017114:Liver Failure, Acute / Q000150:complications* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000473:pathology*; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
D000978:Antiparkinson Agents; D007980:Levodopa