Wilson's disease
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A slit-lamp examination since the combination of liver and neuropsychiatric abnormalities suggest Wilson's disease. Although the ceruloplasmin may be within the normal range in as many as 5-25% of patients with Wilson's disease (more frequently so in younger patients), Kayser-Fleischer rings are usually present in those with established neuropsychiatric disease. Measurement of urinary copper would also be appropriate. Liver biopsy is also an acceptable answer if it was combined with quantitative hepatic copper concentration measurement.
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