Case 232

Medical History

A male patient, 42 years old, is admitted to the Alfa Institute of the Hospital das Clínicas-UFMG of Gastroenterology because of a voluminous ascites frame, confusion and dyspnoea. Report of fibrosing chronic liver disease since the age of 18, whose two of his eight siblings share the diagnosis. Physical examination shows disorientation, significant weight loss, dysarthria, resting tremor in the hands, "flapping", the presence of collateral circulation in the abdomen and respiratory effort, with no other changes. In denying of other comorbidities. Negative serology for viral hepatitis.

Image 1: Abdominal MRI, T2-weighted coronal section.


Image 2: 3D SWAN brain MRI, axial section.


Image 3: Brain MRI, GRE T2 sequence axial section.


Image 4: Brain MRI, T2-weighted FLAIR axial section.

Considering the clinical picture and the changes observed in the magnetic resonance imaging (MRI), the most likely diagnosis is:

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