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NEUROLOGY 1993;43:65
© 1993 American Academy of Neurology

Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure

A. Pujol, MD, J. Pujol, MD, F. Graus, MD, A. Rimola, MD, J. Peri, MD, J. M. Mercader, MD, J. C. García-Pagan, MD, J. Bosch, MD, J. Rodés, MD and E. Tolosa, MD

Department of Neurology (Drs. A. Pujol, Graus, and Tolosa), Liver Unit (Drs. Rimola, García-Pagan, Bosch, and Rodés), and Department of Radiology (Drs. Peri and Mercader), Hospital Clínic i Provincial, University of Barcelona; and the Department of Neurology (Dr. J. Pujol), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Hyperintense globus pallidus on T1 weighted MRI is present in most patients with advanced liver disease. We evaluated the relationship between the signal intensity of the globus pallidus and clinical or laboratory data of 77 patients eligible for liver transplantation. There was a significant correlation between the intensity of the signal and the Child-Pugh score (as indication of severity of liver disease), presence of postural tremor, previous episodes of variceal bleeding or hepatic encephalopathy, prothrombin activity, serum aspartate and alanine aminotransferase, bilirubin, and the indocyanine green (ICG) hepatic clearance, a very sensitive marker of liver function. The multivariate analysis disclosed that the ICG hepatic clearance and previous episodes of variceal bleeding were independently associated with the signal intensity in the globus pallidus. MRI repeated in 21 patients 10 to 20 months after transplant showed a disappearance of the lesion in all cases. We conclude that the hyperintense globus pallidus is secondary to the severity of the liver disease, and is reversible when liver function returns to normal.

Address correspondence and reprint requests to Dr. Francesc Graus, Department of Neurology, Hospital Clínic i Provincial, Villarroel 170, 08036 Barcelona, Spain.

Received April 7,1992. Accepted for publication in final form June 9, 1992.




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