A Case Report of Acquired Hepatocerebral Degeneration Mimicking Parkinson's Disease in Presumed Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-Related Cirrhosis.

Acquired hepatocerebral degeneration (AHD) is a rare chronic neurological syndrome associated with advanced liver disease and portosystemic shunting, characterized by neuropsychiatric and extrapyramidal manifestations resembling those seen in hepatolenticular degeneration (Wilson's disease). We report a rare case of AHD presenting as rapidly progressive parkinsonism with cognitive decline. A 64-year-old man with poorly controlled type 2 diabetes mellitus and obesity developed progressive tremor, gait instability, recurrent falls, and worsening cognition. Initial assessment suggested benign tremor and early Parkinson's disease; however, further evaluation demonstrated cirrhosis with portal hypertension, hyperammonaemia, and hepatic encephalopathy. Brain imaging revealed characteristic basal ganglia abnormalities consistent with AHD. This case highlights the importance of considering underlying liver disease in patients presenting with atypical parkinsonism and cognitive deterioration and also emphasizes the limited effectiveness of conventional Parkinson's disease therapies in this setting.