Portal Systemic Encephalopathy Presenting with Dressing and Constructional Apraxia

Takeshi Kanda, Shigeru Nogawa, Kazuhiro Muramatsu, Atsuo Koto, Yasuo Fukuuchi

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


We report a case with portal systemic encephalopathy who presented with dressing and constructional apraxia and subtle weakness of the left hand. We initially suspected a cerebrovascular attack in the right cerebral hemisphere, but brain T1-weighted magnetic resonance (MR) imaging revealed high intensity in the basal ganglia and hyperammonemia was detected. We performed abdominal MR angiography, which visualized an intrahepatic portal systemic shunt. Cerebral blood flow, measured by xenon-enhanced computed tomography, was decreased in the bilateral, but more dominantly right-sided, parietal watershed regions. We speculate that these boundary territories might be susceptible to damage by toxic metabolites of hepatic encephalopathy.

Original languageEnglish
Pages (from-to)419-423
Number of pages5
JournalInternal Medicine
Issue number5
Publication statusPublished - 2000 Jan 1


  • Constructional apraxia
  • Dressing apraxia
  • Hepatic encephalopathy
  • Local cerebral blood flow
  • MR angiography
  • Xenon-enhanced CT

ASJC Scopus subject areas

  • Internal Medicine


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