Abstract
Purpose
The present report illustrates two men aged for 59 and 43 years, respectively, who presented with slowly progressive spastic paraparesis.
Study design
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.
References
Ginsberg L (2011) Disorders of the spinal cord and roots. Pract Neurol 11:259–267
Utku U, Asil T, Balci K, Uzunca I, Celik Y (2005) Hepatic myelopathy with spastic paraparesis. Clin Neurol Neurosurg 107:514–516
Wang MQ, Dake MD, Cui ZP, Wang ZQ, Gao YA (2001) Portal-systemic myelopathy after transjugular intrahepatic portosystemic shunt creation: report of four cases. J Vasc Interv Radiol 12:879–881
Yengue P, Adler M, Bouhdid H, Mavroudakis N, Gelin M, Bourgeois N (2001) Hepatic myelopathy after splenorenal shunting: report of one case and review of the literature. Acta Gastroenterol Belg 64:231–233
Qu B, Liu C, Guo L, Yang Y, Li JH, Yu L, Lv Y (2009) The role of liver transplantation in the treatment of hepatic myelopathy: case report with review of the literature. Transplant Proc 41:1987–1989
Mendoza G, Marti-Fabregas J, Kulisevsky J, Escartin A (1994) Hepatic myelopathy: a rare complication of portacaval shunt. Eur Neurol 34:209–212
Pant SS, Bhargava AN, Singh MM, Dhanda PC (1963) Myelopathy in hepatic cirrhosis. Br Med J 1:1064–1065
Campellone JV, Lacomis D, Giuliani MJ, Kroboth FJ (1996) Hepatic myelopathy. Case report with review of the literature. Clin Neurol Neurosurg 8:242–246
Weissenborn K, Tietge UJ, Bokemeyer M, Mohammadi B, Bode U, Manns MP et al (2003) Liver transplantation improves hepatic myelopathy: evidence by three cases. Gastroenterology 124:346–351
Caldwell C, Werdiger N, Jakab S, Schilsky M, Arvelakis A, Kulkarni S et al (2010) Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature. Liver Transpl 16:818–826
Conflict of interest
None of the authors has any potential conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ben Amor, S., Saied, M.Z., Harzallah, M.S. et al. Hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature. Eur Spine J 23 (Suppl 2), 167–171 (2014). https://doi.org/10.1007/s00586-013-2828-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2828-z