Reversal of parkinsonism following liver transplantation

Acquired non-Wilsonian hepatic-cerebral degeneration (AHCD) may manifest as a psychiatric or neurologic disturbance. Clinical manifestations include movement disorders (ataxia, tremor, chorea, parkinsonism, myoclonus, and dystonia), neuropsychiatric disturbances (apathy, lethargy, and excessive somnolence), or both.1,2⇓ Rarely has levodopa-responsive parkinsonism been reported.1 There is a lack of correlation between the location of lesions and clinical symptomatology.3,4⇓ We present a patient with liver failure with severe parkinsonism, which resolved after liver transplantation. A 70-year-old man presented with a 15-month history of progressive tremor (kinetic > resting), which began in his upper-right extremity, spread to the left hand and both legs. He began to drag his feet, had difficulty getting up from a chair, and required assistance in the activities of daily living. Six months before his initial neurologic evaluation, he developed gait imbalance. Cirrhosis and liver failure were diagnosed 3 years earlier after an episode of altered mental status. Neurologic examination was normal, except for masked facies, hypophonic speech, moderate resting, postural, and kinetic tremor of both upper extremities. There was asymmetric loss of finger dexterity, prominent cogwheel …