Abstract A serious mental disorder that can occur among individuals with acute or chronic liver failure is hepatic encephalopathy (HE). Both the basal ganglia and thalamus are deep gray matter structures prone to damage from various disorders due to their high metabolic activity. Most disease processes result in bilateral lesions, which can be either symmetrical or asymmetrical and often exhibit distinctive patterns in imaging studies. Typical brain magnetic resonance imaging findings of HE include bilateral basal ganglia hyper intensities due to manganese deposition in chronic liver disease and hyper intensity seen in T2-weighted imaging. Fluid-attenuated inversion recovery, diffusion-weighted imaging with hemisphere white matter changes, including the corticospinal tract. Neuropsychological impairment in HE, however, varies from modest psychomotor impairments that impair quality of life to stupor or coma associated with more severe hepatic dysfunction. Because chronic liver illness has long-lasting compensating mechanisms for the altered metabolism, imaging results for HE are surprisingly variable. As a result, it can be challenging to distinguish HE from other metabolic disorders and to determine the clinical significance of imaging results. Here, we report the case of a 40-year-old male who has been diagnosed with liver cirrhosis and who frequently has bouts of HE with bilateral symmetrical basal ganglia hyper-intensities on neuroimaging.
Rode et al. (Mon,) studied this question.