Title:Hepatic Encephalopathy by Manganese Deposition: A Case Report and a
Review of Literature
Volume: 17
Issue: 3
Author(s): Ludovico Abenavoli*, Giulia Fabiano, Anna Caterina Procopio, Isabella Aquila, Rinaldo Pellicano, Stefania Barone and Maurizio Morelli
Affiliation:
- Department of Health Sciences, University “Magna Graecia”, Catanzaro Italy
Keywords:
Hepatic encephalopathy, Manganese, cirrhosis, liver dysfunction, brain, extrapyramidal symptoms, globi pallidi.
Abstract:
Background: Hepatic encephalopathy is defined as a spectrum of neuropsychiatric disorders
in patients with liver dysfunction, usually cirrhosis, after exclusion of brain disease. This
study reports the role of manganese in brain alterations and clinical manifestations of hepatic encephalopathy.
Case presentation: Male patient, 67 years old, suffering from alcoholic liver cirrhosis and two previous
episodes of hepatic encephalopathy, developed drowsiness, asterixis, amnesia, disorientation
in time and space, and psychomotor retardation. Brain MRI without contrast showed initial signs of
cerebral atrophy, a hyperintense signal of globi pallidi and bilateral substantia nigra. The hyperintense
signal of globi pallidi is the result of manganese deposition in the brain.
Conclusion: The case report presented supports the data reported in the literature, indicating that
the increase in plasma manganese levels in subjects with liver dysfunction is correlated with the onset
of extrapyramidal symptoms.
