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Episodic confusion and tremor associated with extrahepatic portacaval shunting in cirrhotic liver disease

Departments of Neurology and Radiology, University of Alabama at Birmingham, Birmingham, AL.

In an elderly male patient with alcohol-related liver disease, who developed episodic confusion and tremor, we found a large extrahepatic portacaval shunt. He had no clinical or laboratory evidence of liver dysfunction except for an elevated serum ammonia level that increased further in response to an ammonium chloride challenge test. Extrahepatic portacaval shunting causing episodic confusion and tremor may occur with alcoholic liver disease without overt liver failure and may require abdominal angiography or a transhepatic portogram to demonstrate the shunt.

Address correspondence and reprint requests to Dr. Whitaker, Department of Neurology, University of Alabama at Birmingham, UAB Station, Birmingham, AL 35294.

Received July 12, 1988. Accepted for publication in final form September 2, 1988.