Intrahepatic portal-hepatic venous anastomosis: A portal-systemic shunt with neurological repercussions

Intrahepatic shunts are rarely diagnosed as a cause of neurocognirive abnor mality. A complaint of fatigue led to the diagnosis of a right portal vein- hepatic vein aneurysmal communication in a 23-yr-old, otherwise healthy wom an. Neuropsychological testing, imaging, and MR spectroscopy revealed chang es similar to those described in patients with cirrhosis and subclinical he patic encephalopathy. T1-weighted MRI showed a hyperintense globus pallidus , a feature seen in subjects with and without portal-encephalopathy. Portal -systemic shunting in the absence of parenchymal liver disease reproduces n eurological features described in cirrhosis. (Am J Gastroenterol 2000;95: 1 568-1571. (C) 2000 by Am. Cell. of Gastroenterology).