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Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography
A 50-year-old man with liver cirrhosis and esophageal varix for 3 years was diagnosed with hematemesis and treated for a bleeding varix. However, bleeding recurred 11 days later, and he developed drowsiness with left hemiparesis. His left upper and lower extremity muscle strengths based on the manua...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Korean Academy of Rehabilitation Medicine
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351486/ https://www.ncbi.nlm.nih.gov/pubmed/25750884 http://dx.doi.org/10.5535/arm.2015.39.1.138 |
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author | Bang, Hyun Lee, Hye Yeon Kim, Bo-Ram Lee, In-Sik Jung, Heeyoune Koh, Seong-Eun Lee, Jongmin |
author_facet | Bang, Hyun Lee, Hye Yeon Kim, Bo-Ram Lee, In-Sik Jung, Heeyoune Koh, Seong-Eun Lee, Jongmin |
author_sort | Bang, Hyun |
collection | PubMed |
description | A 50-year-old man with liver cirrhosis and esophageal varix for 3 years was diagnosed with hematemesis and treated for a bleeding varix. However, bleeding recurred 11 days later, and he developed drowsiness with left hemiparesis. His left upper and lower extremity muscle strengths based on the manual muscle test at the onset were grade 2/5 and 1/5, respectively. The Babinski sign was positive. His serum ammonia level was elevated to 129.9 µg/dL (normal, 20-80 µg/dL). Magnetic resonance imaging revealed restriction on diffusion and T2-hyperintensities with decreased apparent diffusion coefficient values in the bilateral frontoparietooccipital cortex. The effect was more severe in the right hemisphere and right parietooccipital cortices, which were compatible with hepatic encephalopathy. Although the patient's mental status recovered, significant left-sided weakness and sensory deficit persisted even after 6 months. Diffusion tensor tractography (DTT) performed 3 months post-onset showed decreased volume of the right corticospinal tract. We reported a patient with hepatic encephalopathy involving the corticospinal tract by DTT. |
format | Online Article Text |
id | pubmed-4351486 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Korean Academy of Rehabilitation Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-43514862015-03-06 Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography Bang, Hyun Lee, Hye Yeon Kim, Bo-Ram Lee, In-Sik Jung, Heeyoune Koh, Seong-Eun Lee, Jongmin Ann Rehabil Med Case Report A 50-year-old man with liver cirrhosis and esophageal varix for 3 years was diagnosed with hematemesis and treated for a bleeding varix. However, bleeding recurred 11 days later, and he developed drowsiness with left hemiparesis. His left upper and lower extremity muscle strengths based on the manual muscle test at the onset were grade 2/5 and 1/5, respectively. The Babinski sign was positive. His serum ammonia level was elevated to 129.9 µg/dL (normal, 20-80 µg/dL). Magnetic resonance imaging revealed restriction on diffusion and T2-hyperintensities with decreased apparent diffusion coefficient values in the bilateral frontoparietooccipital cortex. The effect was more severe in the right hemisphere and right parietooccipital cortices, which were compatible with hepatic encephalopathy. Although the patient's mental status recovered, significant left-sided weakness and sensory deficit persisted even after 6 months. Diffusion tensor tractography (DTT) performed 3 months post-onset showed decreased volume of the right corticospinal tract. We reported a patient with hepatic encephalopathy involving the corticospinal tract by DTT. Korean Academy of Rehabilitation Medicine 2015-02 2015-02-28 /pmc/articles/PMC4351486/ /pubmed/25750884 http://dx.doi.org/10.5535/arm.2015.39.1.138 Text en Copyright © 2015 by Korean Academy of Rehabilitation Medicine http://creativecommons.org/licenses/by-nc/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Bang, Hyun Lee, Hye Yeon Kim, Bo-Ram Lee, In-Sik Jung, Heeyoune Koh, Seong-Eun Lee, Jongmin Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography |
title | Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography |
title_full | Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography |
title_fullStr | Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography |
title_full_unstemmed | Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography |
title_short | Hepatic Encephalopathy With Corticospinal Tract Involvement Demonstrated by Diffusion Tensor Tractography |
title_sort | hepatic encephalopathy with corticospinal tract involvement demonstrated by diffusion tensor tractography |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351486/ https://www.ncbi.nlm.nih.gov/pubmed/25750884 http://dx.doi.org/10.5535/arm.2015.39.1.138 |
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