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Case Reports
. 2018 Mar;57(1):181-186.
doi: 10.20471/acc.2018.57.01.25.

Regression of Asymmetric Upper Extremity Tremor After Liver Transplantation in a Patient With Hepatic Encephalopathy: Case Report

Petar Filipović Grčić  1 , Gordan Džamonja  1 , Ana Filipović Grčić  2 , Krešimir Dolić  3 , Meri Matijaca  1 , Marina Titlić  1
Affiliations
Case Reports

Regression of Asymmetric Upper Extremity Tremor After Liver Transplantation in a Patient With Hepatic Encephalopathy: Case Report

Petar Filipović Grčić et al. Acta Clin Croat. 2018 Mar.

Abstract

Hepatic encephalopathy (HE) is a brain dysfunction caused by liver failure. Clinically, it can manifests as a wide spectrum of neurological or psychiatric abnormalities. This report presents a case of a 43-year-old male with HE and asymmetric kinetic, postural and resting tremor of upper extremities. Magnetic resonance imaging (MRI) of the brain showed signal abnormalities in numerous areas. The patient underwent liver transplantation and six months after normalization of liver function, tremor as well as brain MRI abnormalities almost completely regressed. This case re-port presents the asymmetric and reversible kinetic, postural and resting tremor of upper extremities as part of the spectrum of neurological abnormalities in HE.

Keywords: Case reports; Hepatic encephalopathy; Liver transplantation; Magnetic resonance imaging; Tremor.

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Figures

Fig. 1
Fig. 1
Baseline MRI findings of the brain: (A) axial T1WI MRI demonstrates hyperintensity in the globi pallidi (arrows); (B) sagittal T1WI MRI demonstrates hyperintensity in the substantia nigra (arrow); (C) axial T2WI MRI shows hyperintensity in the nuclei dentati (arrows); (D) axial FLAIR MRI shows hyperintensity in the crura cerebri (arrows) and in the red nuclei (black arrowheads).
Fig. 2
Fig. 2
Follow up brain MRI 6 months after liver transplantation: (A) axial T1WI MRI demonstrates almost complete regression of hyperintensity in the globi pallidi (arrows); (B) sagittal T1WI MRI depicts subtotal regression of hyperintensity in the substantia nigra (arrow); (C) axial T2WI MRI demonstrates regression of hyperintensity in the nuclei dentati; (D) axial FLAIR image shows regression of hyperintensity in the crura cerebri and in the red nuclei.
See this image and copyright information in PMC

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