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NH3 to produce hepatic encephalopathy This theory and others has been the subject of reviews by Butterworth and coworkers, by Zieve, by Rothstein and Herlong, and by Jones and Basile, to which the reader is referred for detailed information Also in recent years, manganese has emerged as a potential neurotoxin in the pathogenesis of hepatic encephalopathy (Kreiger et al; Pomier-Layrargues et al) In patients with chronic liver disease and with spontaneous or surgically induced portal-systemic shunts, manganese accumulates in the serum and in the brain, more speci cally in the pallidum This accumulation is readily discernible as a pallidal signal hyperintensity on T1-weighted MRI Following liver transplantation, there is normalization of the MRI changes and of the associated extrapyramidal symptoms The effects of manganese chelation on such patients have not been studied, and the mechanisms of accumulated manganese in the pathogenesis of hepatic encephalopathy are not known. free barcode generator asp.net c# C# Barcode Generator in ASP . 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