UNASSIGNED: A 57-year-old Japanese woman presented with recurrent severe depression, pain, and somatosensory hallucinations, along with fluctuating motor dysfunction, including parkinsonism, and cognitive impairments. Psychiatric interventions, including antidepressants, antipsychotics or electroconvulsive therapy, had limited efficacy or did not prevent relapse.
UNASSIGNED: T1-weighted MRI showed bilateral hyperintensity in the globus pallidus. No history of Mn exposure or metabolic abnormalities, including copper, was identified. Furthermore, no evidence of liver dysfunction or hyperammonemia was found. Eventually, a gastrorenal shunt was observed on contrast-enhanced abdominal computed tomography. The diagnosis of AHD due to CPSS was made based on the clinical manifestations and abnormal imaging findings. Shunt embolization was performed, which prevented the relapse of psychiatric symptoms and substantially reduced the T1-weighted MRI hyperintensities.
UNASSIGNED: This case highlights the potential involvement of AHD in adult-onset psychiatric symptoms, even in the absence of liver disease. Furthermore, this case underscores the efficacy of shunt embolization in treating the psychiatric symptoms of AHD due to CPSS.
■一名57岁的日本女性出现反复发作的重度抑郁症,疼痛,和体感幻觉,伴随着波动性的运动功能障碍,包括帕金森病,和认知障碍。精神病学干预,包括抗抑郁药,抗精神病药或电惊厥疗法,疗效有限或不能预防复发。
■T1加权MRI显示苍白球双侧高强度。无锰暴露史或代谢异常,包括铜,已确定。此外,未发现肝功能障碍或高氨血症的证据.最终,在对比增强的腹部计算机断层扫描中观察到胃肾分流。根据临床表现和异常影像学表现诊断为CPSS所致的AHD。进行分流栓塞,这防止了精神症状的复发,并大大降低了T1加权MRI高强度。
该病例突出了AHD在成人发病的精神症状中的潜在参与,即使没有肝病。此外,该病例强调了分流栓塞治疗CPSS引起的AHD精神症状的疗效。