Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt.
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.
Koo
Ja Eun
JE
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lim
Young-Suk
YS
Myung
Sun Jeong
SJ
Suh
Kyung Suk
KS
Kim
Kang Mo
KM
Lee
Han Chu
HC
Chung
Young-Hwa
YH
Lee
Yung Sang
YS
Suh
Dong Jin
DJ
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*