Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2674  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (805 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1054    
    Printed16    
    Emailed0    
    PDF Downloaded43    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 4  |  Page : 872-873

Under recognized cause of reversible cognitive decline: A radiological aid


Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication5-Jul-2017

Correspondence Address:
Manoj K Goyal
Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_1244_16

Rights and Permissions



How to cite this article:
Kumar AS, Shree R, Sachdeva J, Patil A, Goyal MK, Lal V. Under recognized cause of reversible cognitive decline: A radiological aid. Neurol India 2017;65:872-3

How to cite this URL:
Kumar AS, Shree R, Sachdeva J, Patil A, Goyal MK, Lal V. Under recognized cause of reversible cognitive decline: A radiological aid. Neurol India [serial online] 2017 [cited 2019 Dec 15];65:872-3. Available from: http://www.neurologyindia.com/text.asp?2017/65/4/872/209495




Sir,

A 55-year old businessman-politician, presented with complaints of memory disturbances with changes in behavior of 6-month duration. Detailed neurological examination revealed a mini-mental state examination of 18/30 with significant impairment of frontal and temporal lobe functions. He was noted to have multiple spider naevi and asterixis. Gadolinium-enhanced magnetic resonance imaging of the brain revealed bilateral, symmetric high signal intensity of the globus pallidi on T1-weighted sequence; diffuse white matter high signal intensities predominantly involving the hemispheric corticospinal tract; and, focal high-signal T2 lesions in the subcortical hemispheric white matter. Diffusion-weighted images showed increased mean diffusivity in hemispheric white matter [Figure 1]. Magnetic resonance (MR) angiogram of intra- and extracranial vessels was normal. Serum ammonia levels were raised. Fibroscan revealed liver stiffness measurement (LSM) of 54.2 kPa, indicating cirrhosis. He was treated with antihepatic coma measures and had significant improvement in symptoms.
Figure 1: (a) T1-weighted MR image showing bilateral, symmetric high signal intensity of the globus pallidi, (b) diffusion-weighted image showing increased mean diffusivity of high-signal T2 lesions in subcortical white matter, (c) zoom images showing high-signal T2 lesions along the corticospinal tracts in bilateral cerebral peduncles

Click here to view


Portosystemic encephalopathy is an under recognized cause of subacute cognitive decline. Bilateral, symmetric high signal intensities of the globus pallidi (particularly medial) on T1-weighted sequences have been reported to be due to increased concentration of manganese deposition.[1] High-signal T2 lesions in subcortical white matter along with increase in mean diffusivity are the result of interstitial brain edema.[2] Early recognition of brain imaging suggestive of portosystemic shunt can lead to a prompt diagnosis of a reversible cause of cognitive decline.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hazell AS. Astrocytes and manganese neurotoxicity. NeurochemInt 2002;41:271-7.  Back to cited text no. 1
[PUBMED]    
2.
Lodi R, Tonon C, Stracciari A, Weiger M, Camaggi V, Iotti S, et al. Diffusion MRI shows increased water apparent diffusion coefficient in the brains of cirrhotics. Neurology 2004;62:762-6.  Back to cited text no. 2
[PUBMED]    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow