Hepatic Myelopathy: Case Report and Review of the Literature

Huanquan Liao, Zhichao Yan, Wei Peng and Hua Hong*

Hepatic Myelopathy: Case Report and Review of the Literature

Patients with Chronic Liver Disease frequently experience neurologic sequel,
usually associated with extensive portosystemic shunt of blood, a liver bypass either by portosystemic anastomosis or as a result of the development of an extensive portosystemic collateral circulation.

The most common and widely recognized is the reversible syndrome of Hepatic Encephalopathy.
There are also comparatively rare and largely irreversible conditions such
as Acquired hepatocerebral degeneration (AHCD) and hepatic
myelopathy (HM) especially the knowledge on HM is sparse.

The predominant neurologic abnormality of HM is the progressive spasticity
and weakness in the lower extremities which often render the patient to become wheelchair bound.
Since Leigh and Card, firstly described the occurrence of HM in 1949, some
single cases or short clinical reports describing patients suffering
from HM have been published worldwide,
but are often scattered.

Herein the author presented one additional case of HM
with typical symptoms and undertook a retrospective survey in a
manner of comprehensive review in order to determine the clinical and
pathophysiological features and treatment of HM.

A 29-year-old man was admitted on November 25,
2009, because of a progressive spastic paraparesis which had
proceeded over the previous 2 months.

The patient complained
for the first time of symptoms of stiffness and weakness of legs.
Gradually his walking became unsteady, tripping over objects.
On admission, he could stand without support but was not able
to walk without help. He walked leaning forward with his feet
close together, with ‘step page’ or puppet-like gait.

He was suffering from posthepatitic cirrhosis caused by hepatitis B with a
history of 6 years, having ascites as the initial presentation in
2003, but constantly without prior recurrent episodes of hepatic

Liver Res Open J. 2015; 1(2): 45-55. doi: 10.17140/LROJ-1-108