Case Report on Acquired Hepatocerebral Degeneration

Acquired hepatocerebral degeneration (AHD) is an uncommon neurological manifestation of chronic liver disease, most often associated with portosystemic shunting. The disorder is characterised by a combination of movement abnormalities, cognitive decline, and psychiatric disturbance. Manganese accumulation within the basal ganglia, secondary to impaired hepatic clearance, is considered the principal mechanism. The clinical overlap with more common neurodegenerative disorders frequently delays diagnosis. We describe a patient who presented with tremor, bradykinesia, and reduced facial expression in the context of compensated cirrhosis, whose neuroimaging findings were consistent with AHD. This case underscores the importance of considering AHD in patients with liver disease presenting with extrapyramidal or cognitive symptoms, as early recognition can alter management and improve outcomes.