A Spectrum of Movement Disorders: Asterixis Associated with Chronic Liver Disease: A Case Report

Background: Liver disease is a condition with wide manifestations and can lead to a myriad of complications. The relationship between movement disorder and liver disease should be considered. Movement disorder due to impaired liver function can be precipitated by neurological dysfunction with a wide etiology including abnormally impaired liver detoxification of potentially toxic substances, deranged function of the liver, and/or exposure to exogenous toxins/drugs. Case summary: A male patient aged 44 years complained of jerking of hands and feet. He also had a history of hepatic cirrhosis and chronic hepatitis B for the past 2 years, HBSAg positive, splenomegaly, and portal hypertension signs on ultrasound. Neurological exam revealed involuntary wrist manus and pedis dextra sinistra movements, wrist rhythmic rhythm, medium amplitude (4-5Hz) speed, suggestibility (-), hands and feet area of, stereotypic (+), worse with rest, improves with rest, resembles involuntary movements in flapping tremor or asterixis. Discussion: Compromised liver function in patients with cirrhosis can lead to hepatocerebral degeneration through the filtration of neurotoxins such as ammonia, glutamine, and manganese into circulation. They disrupt astrocyte and neuron communication, leading to presynaptic dopaminergic dysfunction and loss of postsynaptic dopaminergic receptors, those manifesting clinically as dementia and movement disorders including tremor, parkinsonism, dystonia, chorea, and ataxia. Conclusion: There are significant clinical interactions between the liver and central nervous system. Hepatocerebral degeneration should be considered in patients with hepatic cirrhosis who have movement disorders. They comprise movement disorders and intellectual decline, including tremors, dystonia, chorea and ataxia, and parkinsonism.