title: Acquired hepatocerebral degeneration and hepatic encephalopathy: correlations and variety of clinical presentations in overt and subclinical liver disease.
abstract: Acquired hepatocerebral degeneration (AHD) and hepatolenticular degeneration can have similar clinical presentations, but when a chronic liver disease and atypical motor findings coexist, the distinction between AHD and hepatic encephalopathy (HE) can be even more complicated. We describe three cases of AHD (two having HE) with different neuroimaging findings, distinct hepatic diseases and similar motor presentations, all presenting chronic arterial hypertension and weight loss before the disease manifestations. The diagnosis and physiopathology are commented upon and compared with previous reports. In conclusion, there are many correlations among HE, hepatolenticular degeneration and AHD, but the overlapping of AHD and HE could be more common depending on the clinical knowledge and diagnostic criteria adopted for each condition. Since AHD is not considered a priority that affects the liver transplant list, the prognosis in AHD patients remains poor, and flow interruption in portosystemic shunts must always be taken into account.
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, SP, Brazil. fgromeiro@fmb.unesp.br
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Romeiro
authors.forename: Madileine F
authors.initials: MF
authors.lastname: Américo
authors.forename: Fábio S
authors.initials: FS
authors.lastname: Yamashiro
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Caramori
authors.forename: Arthur O
authors.initials: AO
authors.lastname: Schelp
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Santos
authors.forename: Giovanni F
authors.initials: GF
authors.lastname: Silva
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000503:physiopathology; D006527:Hepatolenticular Degeneration / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D018726:Anti-Dyskinesia Agents; D006220:Haloperidol