Dopaminergic neuronal integrity in parkinsonism associated with liver cirrhosis.
OBJECTIVE
To investigate the nature of parkinsonism associated with liver cirrhosis, which entails examination of the integrity of the nigrostriatal dopaminergic system.


METHODS
Consecutive patients who had concurrent liver cirrhosis and parkinsonism were investigated with MRI and dopamine transporter (DAT) single-photon emission computerized tomography (SPECT) using iodine I 123 [(123)I]-radiolabeled fluoropropyl (FP) 2-carbomethoxy-3-(4-iodophenyl) tropane (CIT).


RESULTS
Five patients with liver cirrhosis were identified and confirmed to have concurrent parkinsonism. In all patients, MRI showed increased T1 signals, affecting basal ganglia bilaterally. DAT density was normal in four patients, and these patients had relatively non-progressive, levodopa-unresponsive parkinsonism. In one patient, striatal [(123)I]FP-CIT uptake was reduced, similar to the pattern of idiopathic Parkinson's disease (PD). This patient showed sustained response to levodopa treatment.


CONCLUSIONS
Our patients showed two different patterns of clinical and neuroradiological features, that is, atypical parkinsonism with normal DAT density, which is clearly differentiated from PD versus levodopa-responsive parkinsonism with reduced DAT density (classical PD). Further investigations using other markers of dopaminergic transmission and histopathological studies should be conducted to elucidate whether damage to the nigrostriatal dopaminergic system occurs in parkinsonism associated with liver cirrhosis.
Kim
Jong-Min
JM
Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
Kim
Ji Seon
JS
Jeong
Sook-Hyang
SH
Kim
Yu Kyeong
YK
Kim
Sang Eun
SE
Kim
Suk Hwan
SH
Kim
Yangho
Y
D000368:Aged; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000378:metabolism; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000378:metabolism*; D020734:Parkinsonian Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014326:Tropanes / Q000378:metabolism
D050483:Dopamine Plasma Membrane Transport Proteins; D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane; D007980:Levodopa