Hepatic myelopathy in a patient with decompensated alcoholic cirrhosis and portal colopathy.

Madhumita Premkumar,Premashish Kar,Gaurav Maurya,Shubham Vatsya,Ankit Gupta,Siddharth Kapahtia,Neha Kapoor,Avishek Bagchi

doi:10.1155/2012/735906

Madhumita Premkumar, Premashish Kar + Show 6 more

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https://doi.org/10.1155/2012/735906

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Journal: Case Reports in Hepatology	Publication Date: Jan 1, 2012
Citations: 15	License type: CC BY 3.0

Affiliation: Maulana Azad Medical College

Abstract

Cirrhotic or hepatic myelopathy is a rare neurological complication of chronic liver disease usually seen in adults and presents as a progressive pure motor spastic paraparesis which is usually associated with overt liver failure and a surgical or spontaneous systemic portocaval shunt. We describe the development of progressive spastic paraparesis, in a patient with alcoholic cirrhosis with portal hypertension and portal colopathy who presented with the first episode of hepatic encephalopathy. The patient had not undergone any shunt procedure.

Highlights

Hepatic myelopathy (HM) is an insidious onset pure motor spastic paraparesis without sensory or bladder or bowel involvement in patients with liver disease in which the neurological dysfunction cannot be attributed to another disorder
A progressive spastic paraparesis in patients with hepatic failure was first described by Leigh and Card [1], followed by a detailed description of HM by other authors who observed this rare neurological complication of cirrhosis, especially in patients with portosystemic shunts [2,3,4]
In India, HM was reported for the first time by Pant et al who described two cases of spastic paraparesis in patients with liver cirrhosis, one with a spontaneous portocaval shunt and the other with a surgical portocaval anastamosis [5]

Summary

Introduction

Hepatic myelopathy (HM) is an insidious onset pure motor spastic paraparesis without sensory or bladder or bowel involvement in patients with liver disease in which the neurological dysfunction cannot be attributed to another disorder. The typical clinical presentation of this disorder is of a patient with underlying chronic liver disease, developing progressive pure motor spastic paraparesis with minimal or no sensory deficit and without bowel and bladder involvement. Most patients report prior episodes of hepatic encephalopathy, and in many cases, the development of myelopathy follows the creation of surgical shunts [6,7,8]. Motor-evoked potential studies may be suitable for the early diagnosis of hepatic myelopathy, even in patients with preclinical stages of the disease [10]

Case Presentation

Discussion

Conclusion