title: Transient improvement of acquired hepatocerebral degeneration with parkinsonian symptoms after failed liver transplant: case report and literature review.
abstract: OBJECTIVE
  Acquired (non-Wilsonian) hepato-cerebral degeneration is an infrequent neurologic disorder in patients with liver dysfunction and longstanding portal-systemic shunting. The clinical manifestations include dysarthria, ataxia, tremor, and cognitive dysfunction. Typically, patients with acquired hepatocerebral degeneration respond poorly to medical therapy as the underlying end-stage liver disease remains. Information regarding the effect of orthotopic liver transplant on acquired hepatocerebral degeneration, however, is limited and conflicting.
  
  
  METHODS
  We conducted a review of literature via a PubMed search to summarize the effect of orthotopic liver transplant on acquired hepatocerebral degeneration.
  
  
  RESULTS
  We present a 56-year-old man with compensated hepatitis C cirrhosis who developed acquired hepatocerebral degeneration with Parkinsonian symptoms refractory to conventional Parkinson medical therapy. Orthotopic liver transplant led to marked clinical improvement of the acquired hepatocerebral degeneration. However, the patient developed recurrence of acquired hepatocerebral degeneration 6-week postorthotopic liver transplant as he developed graft failure from aggressive progressive hepatitis C recurrence. Our review found a heterogeneous group of case series, suggesting that the experience with orthotopic liver transplant is variable.
  
  
  CONCLUSIONS
  Our experience demonstrates that orthotopic liver transplant may lead to resolution of acquired hepatocerebral degeneration; however, acquired hepatocerebral degeneration may return with recurrent liver disease. Future studies with long-term follow-up are needed.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Chen
authors.forename: Mazhar
authors.initials: M
authors.lastname: Haque
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D058625:End Stage Liver Disease / Q000209:etiology / Q000601:surgery*; D017809:Fatal Outcome; D006084:Graft Rejection / Q000209:etiology*; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006527:Hepatolenticular Degeneration / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D017211:Treatment Failure
chemical_list: D000978:Antiparkinson Agents; D000998:Antiviral Agents