Myelopathy in Hepatic Disease and Portosystemic Venous Anastomosis

Liversedge, L.A.; Rawson, M.D.

doi:10.1016/s0140-6736(66)90636-2

Cited by 39 publications

(22 citation statements)

References 3 publications

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“…It is noteworthy that significant improvement in the neuropsychiatric syndrome has been defined following prolonged lactulose usage and by Freund et al (11) using a branched chain-enriched amino acid diet. The neuropathological changes observed in non-Wilsonian hepatocerebral degeneration include diffuse astrocytic hyperplasia, microcavitation and zonal necrosis of the deeper parts of the cerebral cortex and of the lenticular nuclei, loss of nerve cells in the cerebral cortex, putamen, thalamus, cerebellar cortex, and dentate nuclei, and loss of axons in the corticospinal tracts in the spinal cord with fibrous gliosis (2,4,12). In the current patient, in whom a portal-systemic shunt had been present for 23 yr, significant neurological improvement had occurred by 3 mo after OLT, and this continued.…”

Section: Discussionmentioning

confidence: 99%

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Improvement in chronic hepatocerebral degeneration following liver transplantation

et al. 1990

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Chronic progressive hepatocerebral degeneration with spastic paraparesis, dementia, dysarthria, ataxia, tremor, and neuropsychiatric symptoms follows long-standing portal-systemic shunting, is associated with structural changes in the central nervous system, and does not respond to conventional therapy for hepatic encephalopathy. A case of advanced chronic liver disease with severe, progressive hepatocerebral degeneration after 23 yr of portal-systemic shunting is reported in whom there was significant objective improvement in intellectual function and in the chronic neurological signs 3 mo after orthotopic liver transplantation and further improvement 12 mo after transplantation.

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Section: Discussionmentioning

confidence: 99%

“…Laboratory investigations showed the following concentrations: serum total bilirubin, 165 µM (12)(13)(14)(15)(16)). An abdominal ultrasound examination revealed a small echo-genic liver with marked splenomegaly and a patent porta-caval shunt.…”

Section: Case Reportmentioning

confidence: 99%

Improvement in chronic hepatocerebral degeneration following liver transplantation

et al. 1990

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“…12,13 In the early stages, demyelination seems to predominate, but as the disease progresses axonal loss occurs, and this is likely to be irreversible. 2,14 Occasionally, demyelination has also been found in the ventral pyramidal tracts, in the posterior columns and spinocerebellar tracts. A recent study also documented in an HM patient a delayed onset posterior column dysfunction (proprioception and vibratory sensory loss) and a small fiber length-dependent axonal polyneuropathy, 15 both progressing concomitantly with the motor deficits.…”

Section: Discussionmentioning

confidence: 99%

“…The hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while there are only a few reports of sensory or sphincter impairment. [1][2][3][4] Motor evoked potentials (MEPs) studies disclosed MEP abnormalities even in patients with normal clinical examination. 5 However, sensory function has poorly been explored in HM patients.…”

Section: Introductionmentioning

confidence: 99%

Central motor and sensory conduction in patients with hepatic myelopathy

Nardone

Orioli²,

Höller

et al. 2014

Spinal Cord

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Study design: Experimental neurophysiological study. Objectives: The hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while there are only a few reports of sensory impairment. However, sensory function has been poorly explored in HM. We believe that an electrophysiological assessment of dorsal columns by somatosensory evoked potentials (SEPs) and of cortico-spinal lateral tracts by motor evoked potentials (MEPs) should be of considerable value in the functional evaluation of the spinal cord involvement in patients with HM. Setting: Salzburg (Austria) and Merano (Italy). Methods: Eight patients diagnosed with HM were studied with MEPs and SEPs. Neurological examination revealed different degrees of cortico-spinal tract involvement in all patients and sensory abnormalities in three patients. Results: Central motor conduction to lower limb muscles was abnormal in all patients, while central sensory conduction was abnormal in seven out of the eight patients. Both central motor and sensory conduction to upper limbs are normal in all patients. Conclusion:The main finding is that electrophysiological evidence of central sensory involvement is present in a very high percentage of patients with HM, and that the threshold for electrophysiological abnormalities is below that for clinical manifestations. Therefore, central sensory and motor conduction studies are sensitive methods for detecting, localizing and monitoring spinal cord damage in HM.

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“…Myelopathy associated with alcoholism usually occurs in patients who heavily consume alcohol and have cirrhosis and portosystemic blood shunting (1,2). On the other hand, Sage et al (3) proposed another syndrome of progressive posterior and lateral column dysfunction in alcoholic myelopathy without substantial liver disease.…”

Section: Introductionmentioning

confidence: 99%

Lhermitte's Sign in Alcoholic Myelopathy without Portosystemic Shunting: MRI Evaluation

et al. 2005

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We conducted spinal MR imaging on a 35-year-old man with Lhermitte's sign that had manifested over the previous 4 years. He had consumed more than 500 ml of whisky daily for at least 10 years. However, he did not show any evidence of severe liver disease with hepato-systemic blood shunting. Neurologic examination revealed markedly depressed sense of vibration in the feet and mild spasticity in the lower limbs, together with Lhermitte's sign. MR imaging revealed abnormal signal intensity in the posterior column spanning the whole length of the upper cervical cord, which is consistent with Lhermitte's sign.

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Myelopathy in Hepatic Disease and Portosystemic Venous Anastomosis

Cited by 39 publications

References 3 publications

Improvement in chronic hepatocerebral degeneration following liver transplantation

Improvement in chronic hepatocerebral degeneration following liver transplantation

Central motor and sensory conduction in patients with hepatic myelopathy

Lhermitte's Sign in Alcoholic Myelopathy without Portosystemic Shunting: MRI Evaluation

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