title: Hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature.
abstract: OBJECTIVE
  The present report illustrates two men aged for 59 and 43 years, respectively, who presented with slowly progressive spastic paraparesis.
  
  
  METHODS
  Two case reports and review of literature.
  
  
  METHODS
  The patent's history, clinical examination, biology, magnetic resonance imaging (MRI) findings and treatment are reported. We also discuss the pathogenesis and various treatment options.
  
  
  RESULTS
  Neurologic examination showed spastic paraparesis without other neurological disorders. MRI of the spinal cord and brain were normal. Cytologic examination of cerebrospinal fluid from each patient was normal. Hemogram disclosed a pancytopenia. Partial thromboplastin time was prolonged. Liver function tests revealed raised serum bilirubin, normal alanine aminotransferase and aspartate aminotransferase, reduced total protein and albumin. Plasma ammonia was elevated. Blood vitamin B12 and folate values were in normal ranges. Serum antibodies to human T cell lymphotropic virus, human immunodeficiency virus, syphilis and hepatitis C virus were absent. Hepatitis B virus antibody assay was positive. The electromyographic evaluation for second motor neuron involvement was also normal. Endoscopy revealed esophageal varices and a spleno-renal shunt.
  
  
  CONCLUSIONS
  Hepatic myelopathy remains a default diagnosis assigned only after the exclusion of other causes of spastic paraparesis and partial transverse myelopathy. An accurate history, along with appropriate imaging and laboratory findings, is crucial.
authors.affiliation: Department of Neurology, Sahloul Hospital, Belt drive, 4054, Sahloul city, Sousse, Tunisia, kaffelsana@yahoo.fr.
authors.forename: Sana
authors.initials: S
authors.lastname: Ben Amor
authors.forename: Mohamed Zakaria
authors.initials: MZ
authors.lastname: Saied
authors.forename: Mohamed Salah
authors.initials: MS
authors.lastname: Harzallah
authors.forename: Sofiene
authors.initials: S
authors.lastname: Benammou
mesh_terms: D000328:Adult; D000641:Ammonia / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000150:complications; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010198:Pancytopenia / Q000209:etiology; D020336:Paraparesis, Spastic / Q000209:etiology*; D010314:Partial Thromboplastin Time; D011859:Radiography; D012082:Renal Veins / Q000002:abnormalities / Q000000981:diagnostic imaging; D013162:Splenic Vein / Q000002:abnormalities / Q000000981:diagnostic imaging
chemical_list: D000641:Ammonia