Clinical and Experimental Evidence of Cirrhosis-Related Parkinsonism

Abstract

The clinical significance of hepatic encephalopathy (HE) includes a variety of neuropsychiatric abnormalities arising from both chronic and acute hepatic failures. Cirrhotic patients manifest symptoms related to acquired hepatolenticular degeneration (parkinsonism in cirrhosis); the disease is characterized by extrapyramidal symptoms including hypokinesia, dystonia, and rigidity that are rapidly progressive and independent of the severity of cognitive dysfunction, while imaging techniques revealed T1-weighted hyperintense signals in the globus pallidus (GP) and substantia nigra (SN) along with manganese (Mn) deposition leading to the dysfunction of the dopaminergic, glutamatergic, as well as GABAergic neurotransmitter systems in the basal ganglia. Through the chapter, the authors emphasize the common neurological and cognitive features between Parkinson's disease/parkinsonism and HE with a special focus on the underlying pathophysiological mechanisms.