Diverse neurological symptoms in chronic liver failure: Difficulties in etiological diagnosis [Kronik karaciǧer yetmezliǧinde nörolojik belirtilerin çeşitliliǧi: Etiyolojik tani{dotless}daki zorluklar]

Acquired hepatocerebral degeneration (ahcd) describes a neurological disorder in the context of chronic hepatic failure which is not related to acute encephalopathy and not explained by an alternative cause. patients with ahcd may have cognitive deficits,cerebellar findings,hypo- or hyperkinetic movement disorders,and sometimes myelopathy with typical magnetic resonance imaging (mri) abnormalities,particularly t1 hyperintensity in the internal pallidum. here,we report five patients ranging between 45-73 years-old. all had liver disease,four of them were diagnosed as chronic liver failure and one had portosystemic shunts secondary to portal vein thrombosis. presenting neurological symptoms were parkinsonism (4),ataxia (3),postural and action tremor (3) and cognitive deficit (2). mri findings were compatible with ahcd. this report shows the variability of neurological symptoms in ahcd. possibility of liver disease or portosystemic shunts should be kept in mind before diagnosing any neurodegenerative disease and giving treatments toxic to the liver since neurological symptoms may occur in the presence of normal liver enzymes in some liver diseases causing neurological symptoms.