Portal-Systemic Myelopathy after Transjugular Intrahepatic Portosystemic Shunt Creation: Report of Four Cases

Wang, Mao Qiang; Dake, Michael D.; Cui, Zhi; Wang, Zhi Qiang; Gao, Yu

doi:10.1016/s1051-0443(07)61514-0

Cited by 13 publications

(4 citation statements)

References 7 publications

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“…[1,8] HM was initially noted following surgical placement of a portacaval shunt, but it may also occur after transjugular intrahepatic portosystemic shunt (TIPS). [9] Our patient had cirrhosis at the time of presentation and also had additional spontaneous portacaval shunting. Doppler and CT scan confirmed the functioning of lienorenal shunt.…”

Section: Discussionmentioning

confidence: 74%

Hepatic myelopathy: A rare complication following extrahepatic portal vein occlusion and lienorenal shunt

et al. 2006

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A 19-year-old gentleman presented with slowly progressive spastic paraparesis, 2 years after the therapeutic lienorenal shunt for portal hypertension secondary to cirrhosis and portal vein occlusion. After 2 years of initial evaluation, the motor functions had not worsened further. He did not have any obvious clinical or EEG features of hepatic encephalopathy. Other causes for myelopathy were ruled out. Contribution of portal vein occlusion to portosystemic shunting has not been reported previously in patients with 'hepatic myelopathy.' This uncommon complication needs to be considered in patients with shunt surgery for relieving portal hypertension.

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Section: Discussionmentioning

confidence: 74%

Hepatic myelopathy: A rare complication following extrahepatic portal vein occlusion and lienorenal shunt

et al. 2006

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“…Wang et al noted progressive spastic paraparesis with lower limb hyperreflexia and Babinski signs in 4 out of 212 patients who underwent TIPs, with onset between 5 weeks and 5 months after TIPS creation. Spinal fluid analysis was within normal range and there were no signs of compression on imaging (12). In some cases, development of HP was reported a few years following spontaneous or therapeutic splenorenal shunting (13,14).…”

Section: Discussionmentioning

confidence: 98%

From cirrhosis to paraparesis

Lupescu¹,

Iacob²,

Lupescu³

et al. 2019

Ro J Neurol.

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We present the case of a 61-years-old male, diagnosed with liver cirrhosis, portal hypertension and type II diabetes mellitus, who developed bilateral signs of parkinsonism, intention tremor and spastic paraparesis. Based on laboratory workup, brain CT, brain MRI and thoraco-lumbar MRI, a diagnosis of acquired hepato-cerebral degeneration with hepatic paraparesis was established. Although a rare entity, hepatic paraparesis needs to be considered in the right setting. As a result, we describe its key features, as well as new concepts that have emerged in recent years using advanced imaging, with emphasis on pathogenesis.

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“… 30 (4) Prolonged portal hypertension can lead to the stagnation of the vertebral venous plexus in the thoracic and lumbar segments, causing chronic ischemia, hypoxia, and nutrient metabolism disorders of the thoracolumbar spinal cord after the portal venous shunt, ultimately resulting in degeneration and necrosis. 31 Portal shunts are considered essential for the development of HM. However, it has been previously reported that even in the absence of a portal venous system shunt, a large amount of blood may enter the somatic circulation from the portal venous system via a small lateral branch, leading to symptoms in some patients with HM.…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation Reverses Hepatic Myelopathy in the Decompensated Phase of Cirrhosis: Case Report and Literature Review

2024

JCTH

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Hepatic myelopathy (HM) is a rare neurological complication in the end stage of many liver diseases and is characterized by bilateral spastic paraparesis without sensory and sphincter dysfunction. It occurs owing to metabolic disorders and central nervous system dysfunction associated with cirrhosis. Without timely and effective clinical intervention, the prognosis of these patients is devastating. Although liver transplantation (LT) is an effective treatment for HM, the prognosis of these patients remains unsatisfactory. Early recognition and diagnosis of this disease are essential for improving patient prognosis. Here, we report a case of hepatitis B virus-associated decompensated cirrhosis with HM. The patient recovered well after LT. We also summarize the clinical characteristics and post-transplant outcomes of 25 patients with HM treated by LT through 2023, including this case.

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Portal-Systemic Myelopathy after Transjugular Intrahepatic Portosystemic Shunt Creation: Report of Four Cases

Cited by 13 publications

References 7 publications

Hepatic myelopathy: A rare complication following extrahepatic portal vein occlusion and lienorenal shunt

Hepatic myelopathy: A rare complication following extrahepatic portal vein occlusion and lienorenal shunt

From cirrhosis to paraparesis

Liver Transplantation Reverses Hepatic Myelopathy in the Decompensated Phase of Cirrhosis: Case Report and Literature Review

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