Korean J Hepatol > Volume 6(1); 2000 > Article
The Korean Journal of Hepatology 2000;6(1): 24-32.
원저 : 추체외로 증상을 나타낸 간경변 환자에서 담창구 부위의 자기공명 신호증강과 혈중 망간농도와의 상관성 ( Relationship to Magnetic Resonance Signal Hyperintensity in Globus Pallidus and Blood Manganese Concentration in Cirrhotic Patients with Extrapyrami
Relationship to Magnetic Resonance Signal Hyperintensity in Globus Pallidus and Blood Manganese Concentration in Cirrhotic Patients with Extrapyramidal Symptoms
Il Hyun Baek, M.D., Byung-Ho Kim, M.D., Dong Kuen Lee, M.D., Yo Seb Han, M.D., Dae Il Jang, M.D.*, Woo Suk Choi, M.D.†, Kyung Jin Kim, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Young Woon Chang, M.D., Joung Il Lee, M.D., Rin Chang, M.D.
Departments of Internal Medicine, Neurology* and Radiology†, Kyung Hee University College of Medicine, Seoul, Korea
Abstract
Backgroud/Aims : Increasing evidence suggests that manganese deposition in globus pallidus is responsible for MRI signal hyperintensity and for extrapyramidal symptoms in cirrhotics. However, the relationships between blood manganese, the severity of liver dysfunction, the pallidal signal intensity, and neurological signs have not been well established.
Methods:
Blood manganese concentrations were measured together with brain MRI and neurological evaluation in six controls, six patients with Parkinson's disease with normal liver function, and fourteen cirrhotic patients with hepatic encephalopathy including six cirrhotics with extrapyramidal symptoms. The neurological state was evaluated using the Columbia scale and the pallidal index (PI). The ratio of globus pallidus to frontal subcortical white-matter signal intensity was measured-multiplied by 100.
Results
: Pallidal signal hyperintensity was observed in 85.7% of cirrhotics, and the PI was higher in cirrhotics with extrapyramidal signs or high grade varices than those without them, but there was no increase in the Parkinson's disease patients. No correlations were demonstrated between the blood manganese level and PI as well as the Child-Pugh score. The blood manganese level was not significantly different between cirrhotics and other groups. However, there was an overt increase only in two cirrhotic patients with extrapyramidal signs. The Columbia scale did not reveal any correlations with the blood manganese level and the Child-Pugh score.
Conclusions:
Cirrhotics with extrapyramidal signs showed a significant increase in PI, but there was no increase in the patients with Parkinson's disease. The PI was not significantly correlated with the blood manganese level. These findings suggest that extrapyramidal signs in cirrhotics might be caused by a different mechanism than those in Parkinson's disease, which could possibly be related with manganese. (Korean J Hepatol 2000;6:24-32)
KeyWords: Hepatic encephalopathy, Extrapyramidal sign, Blood manganese, Pallidal index, Magneticresonance image
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