Hepatic myelopathy: an unusual neurological complication of chronic liver disease presenting as quadriparesis

Kori, Prakash; Sahu, Ritesh; Jaiswal, Anupam; Shukla, Rakesh

doi:10.1136/bcr-2013-009078

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…Thoracic spinal cord involvement is more common and spinal cervical cord involvement is rarely seen [ 5 ]. Hepatic myelopathy with quadriparesis is rarely reported in the literature (KORI).…”

Section: Discussionmentioning

confidence: 99%

“…Toxic, hemodynamic, metabolic, and nutritional factors are incriminated [ 6 ]. The toxic impact of the ammonia and other neurotoxins on the spinal cord is well known and can be explained by hepatic insufficiency and important spontaneous or surgical portocaval shunt [ 5 , 6 ]. Impairment of liver function is also responsible of deficiencies of essential nutrients for the nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…The disease is characterized clinically by gait disorder, spastic paraparesis, and pyramidal syndrome without bladder or sensitive disorders [4]. Thoracic spinal cord involvement is more common and spinal cervical cord involvement is rarely seen [5]. Hepatic myelopathy with quadriparesis is rarely reported in the literature (KORI).…”

Section: Discussionmentioning

confidence: 99%

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Hepatic myelopathy neurological complication of chronic liver disease: two case reports

Mhiri,

Ben Abdelwahed,

Dhiflaoui

et al. 2024

J Med Case Reports

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Background Hepatic myelopathy is a very rare neurological complication of chronic liver disease. Patients habitually present with progressive pure motor spastic paraparesis. This neurological dysfunction is almost always due to cirrhosis and portocaval shunt, either surgical or spontaneous. Cases report We report two cases of a 57-year-old man and a 37-year-old woman with progressive spastic paraparesis linked to cirrhosis and portal hypertension. The two patients are of Tunisian origin (north Africa). Magnetic resonance imaging of the spinal cord of two patients was normal, while brain magnetic resonance imaging showed a T2 hypersignals of the pallidums. These signs, in favor of hepatic encephalopathy in the two patients with cirrhosis with isolated progressive spastic paraparesis without bladder or sensory disorders, help to retain the diagnosis of hepatic myelopathy. Conclusion Hepatic myelopathy is a severe and debilitating neurological complication of chronic liver disease. The pathogenesis is misunderstood and seems to be multifactorial, including the selective neurotoxic role both of ammonia and other pathogenic neurotoxins. Usually a pathological brain magnetic resonance imaging showing a hepatic encephalopathy was documented, contrasting with a normal spinal cord magnetic resonance imaging that contributed to diagnosis of hepatic myelopathy. Conservative therapies such as ammonia-lowering measures, diet supplementation, antispastic drugs, and endovascular shunt occlusion show little benefit in improving disease symptoms. Liver transplantation performed at early stage can prevent disease progression and could probably allow for recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hepatic myelopathy neurological complication of chronic liver disease: two case reports

Mhiri,

Ben Abdelwahed,

Dhiflaoui

et al. 2024

J Med Case Reports

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show abstract

“…Hepatic myelopathy is an unusual neurological complication of chronic liver disease, causing progressive symmetrical loss of myelin in the lateral pyramidal tracts with spastic plegia in extremities with minimal sensory deficit (2). Early diagnosis and early treatment, like liver transplantation, is crucial to improving quality of life (3).…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation in Hepatic Myelopathy

Acar¹

2021

Hepatology Forum

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Hepatic myelopathy is a rare neurological complication of liver cirrhosis, that involves spastic paraplegia caused by lateral cord demyelinisation especially due to accumulation of some metabolites such as ammonia and manganese. We report a young adult woman presenting with spasticity and paraparesia in extremities after TIPS application and undergone to deceased liver transplantation. 39 year old woman underwent deceased liver transplantation cause of cyriptogenic liver cirrhosis. She underwent TIPS procedure 5 years ago. After that, hepathic encephalopathy and spasticity appeared. She waited in waiting list for 3 years.Neurological findings after liver transplantation significantly decreased, but did not return to normal. Hepatic myelopathy is very rare. LT can provide improvement in neurologic findings.After the emerge of neurological findings, the earlier LT, the better clinical to return to normal.

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“…In contrast, a myelopathic syndrome can occur in alcoholic hepatic failure, attributed to portosystemic shunting of blood, with resultant hyper-ammonaemia and demyelination of corticospinal tracts. [2][3][4] Conclusion Alcohol associated toxic myelopathy is a rare entity, distinct from hepatic myelopathy. It is thought to result from direct toxic effects of ethanol on corticospinal and large myelinated sensory tracts.…”

mentioning

confidence: 93%

061 Training in headache in australia, new zealand and asia

Zhang

Jenkins

Stark

et al. 2019

J Neurol Neurosurg Psychiatry

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IntroductionMigraine is the leading cause of age-adjusted neurological disability in Australia, but little is known about headache training in our region. We aimed to assess the quantity of teaching in headache subjects during undergraduate and postgraduate years.MethodThis is a cross-sectional survey study where questionnaires were sent to 137 delegates from Australia, New Zealand and Asia, prior to the Headache Master School in Sydney in August 2018. The Main outcome measured are recalled number of hours of teaching in undergraduate year and postgraduate years in: 1) Migraine; 2) Trigeminal autonomic cephalalgias (TACs); 3) Asthma; 4) Myasthenia gravis (MG).ResultsThe questionnaire response rate was 73% (100 of 137), of which 29 delegates were within 10 years of completing their undergraduate degree and 98 were neurologists. In undergraduate training, there was much greater quantity of teaching in asthma than migraine (Z=5.007, p<0.000) despite both being high-prevalent (asthma 11%, migraine 15–20%) conditions. Similarly, for diseases of medium-to-low prevalence, there was less training in TACs (1/1000), compared to MG (1.2/10,000) (Z=6.196, p<0.000). These major differences in training were also seen in postgraduate years even though overall headache teaching was greater in postgraduate than undergraduate training (p<0.000).ConclusionsDespite the high prevalence and morbidity of headache disorders, they receive less attention in training than conditions with similar prevalence. We propose that headache training opportunities should be improved in our region, particularly in the undergraduate course and preceptorships or fellowships in postgraduate years.

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Hepatic myelopathy: an unusual neurological complication of chronic liver disease presenting as quadriparesis

Cited by 9 publications

References 12 publications

Hepatic myelopathy neurological complication of chronic liver disease: two case reports

Hepatic myelopathy neurological complication of chronic liver disease: two case reports

Liver Transplantation in Hepatic Myelopathy

061 Training in headache in australia, new zealand and asia

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