title: Reversible Parkinsonism and T1W pallidal hyperintensities in acute liver failure.
abstract: 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.
authors.affiliation: Movement Disorder Clinic, Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India.
authors.forename: Annu
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Sachin
authors.initials: S
authors.lastname: Vaidya
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.forename: Joshita
authors.initials: J
authors.lastname: Singh
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Desai
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhatt
mesh_terms: 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
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa