Open AccessSpinal cord involvement in patients with cirrhosis
Author(s) -
Raffaele Nardone,
Yvonne Höller,
Monica Storti,
Piergiorgio Lochner,
Frediano Tezzon,
Stefan Golaszewski,
Francesco Brigo,
Eugen Trinka
Publication year - 2014
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v20.i10.2578
Subject(s) - medicine , cirrhosis , liver transplantation , spasticity , surgery , corticospinal tract , myelopathy , complication , transplantation , spinal cord , hepatic encephalopathy , magnetic resonance imaging , anesthesia , gastroenterology , radiology , psychiatry , diffusion mri
A severe spinal cord involvement may rarely occur in patients with cirrhosis and other chronic liver diseases; this complication is usually associated with overt liver failure and surgical or spontaneous porto-systemic shunt. Hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while sensory and sphincter disturbances have rarely been described and are usually less important. The diagnosis is assigned in the appropriate clinical setting on clinical grounds after the exclusion of other clinical entities leading to spastic paraparesis. Magnetic resonance imaging is often unremarkable; however, also intracerebral corticospinal tract abnormalities have been reported recently. The study of motor evoked potentials may disclose central conduction abnormalities even before HM is clinically manifest. HM responds poorly to blood ammonia-lowering and other conservative medical therapy. Liver transplantation represents a potentially definitive treatment for HM in patients with decompensated cirrhosis of Child-Pugh B and C grades. Other surgical treatment options in HM include surgical ligation, shunt reduction, or occlusion by interventional procedures.