title: Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt.
abstract: Hepatic myelopathy is a rare complication of chronic liver disease that is associated with extensive portosystemic shunts. The main clinical feature of hepatic myelopathy is progressive spastic paraparesis in the absence of sensory or sphincter impairment. Early and accurate diagnosis of hepatic myelopathy is important because patients with early stages of the disease can fully recover following liver transplantation. Motor-evoked potential studies may be suitable for the early diagnosis of hepatic myelopathy, even in patients with preclinical stages of the disease. Here we describe two patients who presented with spastic paraparesis associated with a spontaneous splenorenal shunt and without any previous episode of hepatic encephalopathy. One patient experienced improved neurologic symptoms after liver transplantation, whereas the other patient only received medical treatment, which did not prevent the progression of spastic paraparesis.
authors: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Ja Eun
authors: JE
authors: Koo
authors: Young-Suk
authors: YS
authors: Lim
authors: Sun Jeong
authors: SJ
authors: Myung
authors: Kyung Suk
authors: KS
authors: Suh
authors: Kang Mo
authors: KM
authors: Kim
authors: Han Chu
authors: HC
authors: Lee
authors: Young-Hwa
authors: YH
authors: Chung
authors: Yung Sang
authors: YS
authors: Lee
authors: Dong Jin
authors: DJ
authors: Suh
mesh_terms: D000328:Adult; D018450:Disease Progression; D019054:Evoked Potentials, Motor / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020336:Paraparesis, Spastic / Q000209:etiology / Q000473:pathology; D012082:Renal Veins / Q000000981:diagnostic imaging*; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D013162:Splenic Vein / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000000981:diagnostic imaging*