Reversal of Parkinsonism and Portosystemic Encephalopathy Following Embolization of a Congenital Intrahepatic Venous Shunt: Brain MR Imaging and 1H Spectroscopic Findings

American Journal of Neuroradiology

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Fig 1.
Initial examination. T1-weighted MR images show bilateral and symmetrical hyperintensities in the substantia nigra and cerebral peduncle (A), subthalamic region and hemispheric white matter (B), and the globus pallidus and putamen (C).
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Fig 2.
Initial examination. ¹H spectroscopy shows decreased mI/Cr and Cho/Cr ratios and an elevated alpha- and beta-, gamma-Glx/Cr peak areas ratios (arrows).
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Fig 3.
Angio-MR examination (A) shows the right branch of portal vein (arrow), the intrahepatic aneurysm (arrowhead), and the right hepatic vein (smaller arrow). Portogram (B) shows the aneurysm (arrow) at the posterior division of the right branch of portal vein. Portogram after embolization (C) shows successful occlusion of the shunt and associated aneurysm.
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Fig 4.
Follow-up examinations after 6 (A, B) and 9 (C, D) months. T1-weighted MR images on the left show a progressive decrease of the symmetrical bilateral high signal intensity in the globus pallidus and putamen, and ¹H spectroscopic measurements on the right show normalization of the mI/Cr and Cho/Cr ratios and a progressive decrease of the alpha- and beta, gamma-Glx/Cr peak areas ratios after 6 and 9 months (arrows).