Partial splenic artery embolization for severe hepatic myelopathy in cirrhosis

Philips, Cyriac Abby; Kumar, Lijesh; Augustine, Philip

doi:10.1002/hep.29597

Cited by 12 publications

(8 citation statements)

References 5 publications

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“…Shunt limiting is preferred, as total shunt occlusion might have a higher risk of adverse events related to the rapid increase of portal hypertension. Moreover, Philips et al [ 22 ] reported partial splenic artery embolization (PSAE) for a patient with HM. Neurological function improved rapidly and constantly after PSAE.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

Chang¹,

Liu²,

Duan³

et al. 2022

World J Clin Cases

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BACKGROUND Hepatic myelopathy (HM) is a rare neurological complication of advanced cirrhosis. Prognosis of patients with HM is generally poor without timely liver transplantation or interventional therapy. Self-resolving HM in patients with alcoholic cirrhosis has never been reported. CASE SUMMARY A 53-year-old man with alcoholic cirrhosis and recurrent overt hepatic encephalopathy for 1 year was admitted for lower extremity weakness, slow movement, and stumbling gait. The patient was diagnosed with HM after excluding other causes of spastic paraparesis. The patient refused liver transplantation. However, the patient kept total abstinence and received a multidisciplinary treatment for complications of decompensated cirrhosis. The symptoms of HM resolved gradually after 2 years of treatment. All complications of alcoholic cirrhosis resolved after 4 years of follow-up. CONCLUSION The case demonstrates that HM can resolve in patients without liver transplan-tation after total abstinence and systemic management of complications.

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Section: Discussionmentioning

confidence: 99%

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

Chang¹,

Liu²,

Duan³

et al. 2022

World J Clin Cases

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“…Diagnostic criteria of HM included 18–21 : (1) a history of chronic liver disease and underwent TIPS treatment; (2) progressive spastic paraplegia, without obvious sphincter and shallow sensory dysfunction; (3) no symptom of spastic paraplegia before TIPS; and (4) normal cerebrospinal fluid and serum blue copper protein, no Kayser-Fleischer ring. Exclusion criteria of HM included 18–21 : (1) spinal cord lesions caused by spinal cord space-occupying mass, multiple sclerosis, hepatolenticular degeneration, infectious, inflammatory, autoimmune, vascular, hereditary, and metabolic causes; (2) severe hepatorenal damage; (3) severe infection and systemic cachexia; (4) serious cardiovascular diseases; and (5) cardiac portal hypertension.…”

Section: Methodsmentioning

confidence: 99%

“…Exclusion criteria of HM included 18–21 : (1) spinal cord lesions caused by spinal cord space-occupying mass, multiple sclerosis, hepatolenticular degeneration, infectious, inflammatory, autoimmune, vascular, hereditary, and metabolic causes; (2) severe hepatorenal damage; (3) severe infection and systemic cachexia; (4) serious cardiovascular diseases; and (5) cardiac portal hypertension.…”

Section: Methodsmentioning

confidence: 99%

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Benefits of Early Treatment for Patients with Hepatic Myelopathy Secondary to TIPS: A Retrospective Study in Northern China

Zhao

Yue

Wang

et al. 2018

Sci Rep

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Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for reducing portal pressure. Hepatic myelopathy (HM), a rare complication of chronic liver diseases, remains obscure in terms of treatment and prognosis. We aimed to determine an optimal treat strategy for patients with HM after TIPS. Twenty-nine patients who developed HM after TIPS were stratified by time-lapse from onset to treatment: group A (n = 16), <6 months; group B (n = 13), ≥6 months. Therapeutic measures included shunt-limiting and medical treatments. Overall survival, lower-limb muscle strength, Fugl-Meyer score, Barthel index, and serum ammonia were recorded. Median survival time in group A or B was 30 months or 16.5 months, respectively (log rank p = 0.0172). All patients in group A obtained improvement in grading of muscle strength (p < 0.0001), Fugl-Meyer score (p = 0.0021), and Barthel index (p = 0.0003), particularly male patients and those subjected to shunt-limiting. Serum ammonia levels were decreased significantly in both group A (p = 0.0007) and group B (p = 0.0007). Collectively, once HM is confirmed after TIPS, active intervention is imperative and urgent, especially within the first 6 months from onset of symptom. TIPS shunt-limiting is particularly beneficial for rehabilitation in patients with early-onset HM.

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“…105 Individual case reports describe improvement with portosystemic shunt occlusion, 111 hepatitis C treatment, 112 and partial splenic artery embolization. 113 Liver transplantation has shown the most promising results in reversing this otherwise invariably progressive syndrome. 105,114,115 Transplantation is most beneficial when performed in the early stage of the disease.…”

Section: Hepatic Myelopathymentioning

confidence: 99%

Metabolic and Toxic Myelopathies

Slama

Berkowitz

2021

Semin Neurol

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Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.

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Partial splenic artery embolization for severe hepatic myelopathy in cirrhosis

Cited by 12 publications

References 5 publications

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

Benefits of Early Treatment for Patients with Hepatic Myelopathy Secondary to TIPS: A Retrospective Study in Northern China

Metabolic and Toxic Myelopathies

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