Corticobasal degeneration or hepatic encephalopathy, False positive and/or congruence between clinic and PET‐FDG imaging

Abstract

AbstractBackgroundto put into perspective the relative clinical evidence meeting the criteria of corticobasal degeneration but modified by the treatment of a metabolic diseaseMethodMultidisciplinary clinical follow‐up of a patient meeting the cognitive, speech and neurological criteria for a degenerative disease by documenting the evolution of both functional, cognitive and functional imaging during the treatment of hepatic encephalopathyResultPt of 82 y/o presents with a deterioration over 6 months of a left extrapyramidal syndrome with dystonia of this hemibody, with a dysphasia‐dysphonia spastic and ataxic documented in speech therapy compatible with corticobasal degeneration. MRI shows mild leukoaraiosis, The FDG PET‐Scan is also compatible with corticobasal degeneration. EEG done for abnormal movements is suggestive of hepatic encephalopathy in the absence of laboratory abnormality except for a very slight increase in ammonia. Ultrasound suggests the onset of liver disease. After 6 months of treatment of encephalopathy there is a slight clinical improvement. After one year of treatment the patient becomes totally autonomous with complete regression of neurological signs, dysexecutive disorders and social cognition deficits and PET‐FDG has normalized. 36 months later he is totally autonomous and is back to works as a historical tour guide.ConclusionIt is impossible for us after 36months of follow‐up to determine whether the metabolic disease has unmasked a degenerative disease early or has simulated it. We review some possible false positive situations on FDG PET‐Scan. DAT‐Scan will be done.