A 63-year-old woman with a portosystemic shunt in the context of hepatic cirrhosis but without history of encephalopathic episodes, had been complaining of arm tremor for six months. Her examination showed a mild extrapyramidal symmetrical parkinsonism with bilateral discrete bradykinesia, symmetric rest and action tremor and slight bilateral arm rigidity (particularly on the right side). She underwent brain magnetic resonance imaging (MRI) which depicted typical findings of acquired hepatocerebral degeneration.

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