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Intrahepatic portal-hepatic venous anastomosis: a portal-systemic shunt with neurological repercussions

2000; Lippincott Williams & Wilkins; Volume: 95; Issue: 6 Linguagem: Inglês

10.1016/s0002-9270(00)00888-1

1572-0241

Jeffrey Crespin, Albert A. Nemcek, Gina Rehkemper, Andrés T. Blei,

Organ Transplantation Techniques and Outcomes

Intrahepatic shunts are rarely diagnosed as a cause of neurocognitive abnormality. A complaint of fatigue led to the diagnosis of a right portal vein–hepatic vein aneurysmal communication in a 23-yr-old, otherwise healthy woman. Neuropsychological testing, imaging, and MR spectroscopy revealed changes similar to those described in patients with cirrhosis and subclinical hepatic encephalopathy. T1-weighted MRI showed a hyperintense globus pallidus, a feature seen in subjects with and without portal-encephalopathy. Portal-systemic shunting in the absence of parenchymal liver disease reproduces neurological features described in cirrhosis.