title: Spinal cord involvement in patients with cirrhosis.
abstract: A severe spinal cord involvement may rarely occur in patients with cirrhosis and other chronic liver diseases; this complication is usually associated with overt liver failure and surgical or spontaneous porto-systemic shunt. Hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while sensory and sphincter disturbances have rarely been described and are usually less important. The diagnosis is assigned in the appropriate clinical setting on clinical grounds after the exclusion of other clinical entities leading to spastic paraparesis. Magnetic resonance imaging is often unremarkable; however, also intracerebral corticospinal tract abnormalities have been reported recently. The study of motor evoked potentials may disclose central conduction abnormalities even before HM is clinically manifest. HM responds poorly to blood ammonia-lowering and other conservative medical therapy. Liver transplantation represents a potentially definitive treatment for HM in patients with decompensated cirrhosis of Child-Pugh B and C grades. Other surgical treatment options in HM include surgical ligation, shunt reduction, or occlusion by interventional procedures.
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Nardone
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Höller
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Monica
authors.initials: M
authors.lastname: Storti
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Lochner
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Frediano
authors.initials: F
authors.lastname: Tezzon
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Golaszewski
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Francesco
authors.initials: F
authors.lastname: Brigo
authors.affiliation: Raffaele Nardone, Yvonne Höller, Stefan Golaszewski, Eugen Trinka, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000818:Animals; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D013116:Spinal Cord / Q000503:physiopathology*; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
keywords: Chronic liver disease; Cirrhosis; Endovascular procedures; Hepatic myelopathy; Liver transplantation; Porto-systemic shunt; Spastic paraparesis