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A 26 year old man with cirrhosis and subacute cognitive decline was admitted with a decrease in his activities of daily living. Hyperpigmentation of his lower extremities, asterixis, and Kayser-Fleischer rings were observed. Neurologic examination revealed psychomotor retardation, upper extremity weakness, hypertonia, a left upper extremity tremor, and extensor plantar responses. Serum ceruloplasmin and …