Choreoathetosis in porto-systemic encephalopathy.

Abstract

A disturbing sequel to the operation of portacaval anastomosis for portal hypertension is the high rate of neuropsychiatric complications. Walker, Shaldon, and Vowles (1961) found that 10 of their first 50 patients who had this operation developed these symptoms within five years, and Read, Laidlaw, and Sherlock (1961) reported that seven of their 21 patients had frank neuropsychiatric disorders and a further seven had symptomless electro-encephalographic changes. > The clinical features of porto-systemic encephalo- pathy in chronic liver disease are extremely varied. The psychiatric manifestations include personality change, intellectual deterioration, and lability of mood, all of which may be episodic in nature. Dis- turbances of sleep rhythm, bizarre behaviour, and sensory disorders may also be found (Davidson and Summerskill, 1956). The neurological abnormalities which have been described have included flapping tremor ofthe outstretched hands, increased tone in the limbs with ankle clonus, and in the later stages extensor plantar responses (Sherlock, 1963). Focal neurological signs such as transient hemiplegia, permanent hemiplegia, and epilepsy have been described (Pearce, 1963) and permanent myelopathy with paraplegia has also been recorded (Zieve, Mendelson, and Goepfert, 1960; Liversedge and Rawson, 1966).