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case_images: T1-weighted magnetic resonance images. Sagittal sections showing a high-signal intensity in the globus pallidus (A) and cerebral peduncle (B), indicating Mn accumulation.
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case_images: T1-weighted MRI revealed high signal findings in the bilateral globus pallidus and cerebral peduncles ( Figures 1A, B ).
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case_images: Abdominal dynamic contrast-enhanced computed tomography images. Horizontal sections showing the late arterial phase. Black arrows indicate the (A) gastrorenal shunt connecting the left gastric vein to the left renal vein. Angiographic image showing enhancement of the portal vein by contrast injection from a catheter placed in the gastrorenal shunt. Black arrows indicate the portosystemic shunt (B) pre-embolization and (C) postembolization.
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case_images: Contrast-enhanced abdominal CT revealed a gastrorenal shunt connecting the left gastric vein to the left renal vein shunt that had a diameter of 10 mm ( Figure 2A ). Digital subtraction angiography revealed the transit of contrast medium from the left renal vein into the portal vein through the gastrorenal shunt, and the absence of portal vein hypoplasia ( Figure 2B ). With the patient's informed consent, shunt embolization was performed, using 12 mm Amplatzer Vascular Plug I ( Figure 2C ).
case_images: T1-weighted magnetic resonance images. Sagittal sections taken 2 years after shunt embolization showing a lower signal intensity in the globus pallidus (A) and cerebral peduncle (B).
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case_images: At age 59, follow-up T1-weighted MRI revealed a significant reduction in the hyperintensities in the globus pallidus and cerebral peduncle ( Figures 3A, B ).
case_images: The patient's disease course and timeline. MRI, Magnetic Resonance Imaging; ECT, Electroconvulsive therapy; AHD, Acquired hepatocerebral degeneration.
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case_images: At age 60, 3 years after shunt embolization, the patient reported no relapses of motor dysfunction or psychiatric symptoms ( Figure 4 ).