Intrahepatic Portosystemic Shunt as a Cause of Recurrent Encephalopathy in a Non-cirrhotic Patient: Successful Combined Transhepatic and Transjugular Embolization

Intrahepatic portosystemic shunts (IPSS) are rare vascular anomalies that can cause recurrent encephalopathy in non-cirrhotic patients.We present a case of a female with recurrent episodes of delirium, in whom initial laboratory tests showed hyperammonemia with preserved hepatic function.Cross-sectional imaging revealed a left-sided IPSS connecting distal branches of the left portal vein to the left hepatic vein.Given her persistent neurocognitive symptoms despite optimal medical therapy, endovascular closure was performed using a dual-access strategy: transhepatic coil embolization of the portal afferent branches, followed by transjugular deployment of an Amplatzer plug in the venous outflow.After the procedure, the patient experienced full resolution of symptoms, with no recurrent neurological episodes during followup.This case highlights the importance of considering IPSS as a reversible cause of unexplained encephalopathy and supports the efficacy of combined-access embolization.