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

• Published in: Journal of medical case reports 2024-06, Vol.18 (1), p.281-5
• Main Authors: Mhiri, Mariem, Ben Abdelwahed, Mehdi, Dhiflaoui, Mohamed Amine, Ben Dhia, Rihab, Gouta, Narjes, Jemni, Imen, Baklouti, Raoua, Zakhama, Mejda, Gueddiche, Arwa, Loghmari, Mohamed Hichem, Ben Chaabene, Nabil, Safer, Leila, Frih-Ayed, Mahbouba
• Format: Article
• Language: English
• Subjects: Adult; Ammonia; Case Report; Chronic Disease; Development and progression; Diagnostic imaging; Diseases; Female; Hepatic Encephalopathy - etiology; Hepatic myelopathy; Humans; Hypertension; Hypertension, Portal - etiology; Liver cirrhosis; Liver Cirrhosis - complications; Magnetic Resonance Imaging; Male; Middle Aged; Neurophysiology; Paraparesis, Spastic - etiology; Shunt; Spastic paraparesis; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - etiology; Transplantation of organs, tissues, etc
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-024-04495-2

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. 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. 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.