Figure 1: a) Axial, and b) Coronal T1-weighted magnetic resonance imaging of the brain showing basal ganglia hyperintensities, more marked in globus pallidus, caudate nucleus and mesencephalon in a patient with chronic hepatic encephalopathy
Case/ Sex (F or M) |
Age |
CP |
etiology |
HE |
Portal HTN º |
Alb (g/dl) |
PT % |
Bili mg/dl |
Serum* ammonia |
Mn** (blood/CSF) |
MRI |
1) F |
74 |
B |
OH |
I |
no |
2,9 |
70 |
2,2 |
31 |
18/3,3 |
+ |
2) F |
62 |
C |
Cryptog |
II-III |
yes |
2,4 |
65 |
1,8 |
70 |
17 |
++ |
3) F |
82 |
A |
OH |
I |
no |
3,8 |
72 |
1,5 |
6 |
2,1 |
+ |
4) M |
61 |
B |
OH |
I |
no |
3,1 |
55 |
1,7 |
14 |
14 |
++ |
5) M |
62 |
C |
OH |
II-III |
Yes |
3,3 |
40 |
2,5 |
200 |
6,2 |
+ |
6) M |
67 |
C |
HCV |
II |
Yes |
3,1 |
40 |
2,4 |
200 |
21 |
++ |
7) F |
51 |
B |
Cryptog |
I-II |
Yes |
4,0 |
65 |
1,2 |
270 |
26 |
+++ |
8) M |
67 |
B |
Cryptog |
I |
Yes |
3,0 |
70 |
2,1 |
97 |
14/2,9 |
++ |
9) M |
54 |
B |
OH |
I-II |
Yes |
3,0 |
50 |
1,2 |
210 |
0,3 |
+ |
10) M |
40 |
B |
PBC |
II-III |
Yes |
3,2 |
55 |
1,8 |
140 |
16 |
++ |
11) F |
45 |
C |
Wilson |
II |
Yes |
2,7 |
45 |
2,5 |
90 |
16 |
++ |
12) M |
53 |
B |
OH |
I-II |
no |
3,0 |
50 |
2,2 |
92 |
1,4 |
+++ |
* Normal range < 30 ug/ml
** Normal range; serum: < 0.06ug/lt; CSF: 0.22 to 0.72 ug/dl.
CSF= cerebral spinal fluid; CP= Child Pugh; Alb= albumin; PT= prothrombin time; OH= ethanol; HCV= hepatitis C virus; HE=hepatic encephalopathy (I to IV grades of West Heaven scale). PBC=primary biliar cholangitis.
ยบ Portal HTN=portal hypertension, considered in case of oesophago-gastric varices, splenomegaly and/or ascitis.
MRI imaging: mild, moderate and severe changes of intensity in basal ganglia (+ to +++).
Table 1: clinical features, laboratory and radiological findings
Score Child-Pugh |
Nº of patients |
Range of blood Mn levels (ug/l)* / mean |
A |
1 |
2.1 |
B |
7 |
0.3 – 26 / 8.4 |
C |
4 |
6.2 – 16 / 15.1 |
*Serum normal range: < 0.06ug/lt
Table 2: Mn levels for each CP score
Figure 1: a) Axial, and b) Coronal T1-weighted magnetic resonance imaging of the brain showing basal ganglia hyperintensities, more marked in globus pallidus, caudate nucleus and mesencephalon in a patient with chronic hepatic encephalopathy
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