Disclosures: Latanya Lofton, MD: No financial relationships or conflicts of interest

Case Description: A 30 year old male was admitted to the inpatient rehabilitation unit with progressive bilateral lower extremity paralysis and pain for the past three months. Initial workup, which included MRI of the cervical, thoracic, and lumbar spine, was essentially negative for any definitive lesions or abnormalities, and lab tests to assess for other possible sources of the paralysis were also negative.

Setting: inpatient rehabilitation hospital

Patient: 30 year old male with progressive bilateral lower extremity spastic paralysis Assessment/

Results: The patient endorsed a history of alcohol use, and liver ultrasound was obtained. The liver ultrasound was consistent with portal hypertension and previous TIPS procedure. He was seen in consultation by neurology and hepatology, and ultimately a diagnosis of hepatic myelopathy was made.

Discussion: Hepatic myelopathy is a rare complication of cirrhosis of the liver. It is a chronic and progressive syndrome, and the primary clinical feature of hepatic myelopathy is spastic paralysis of the bilateral lower extremities with relative sparing of the upper extremities. Patients typically present with increased tone and hyperreflexia. Bowel and bladder function are usually unaffected. Approximately 90% of the reported cases occur in men, and patients typically have a history of hepatic encephalopathy which precedes the development of the myelopathy.

Conclusion: Hepatic myelopathy is a rare complication of cirrhosis and should be considered in the differential diagnosis of patients with non-traumatic spinal cord injury who present with a history of progressive lower extremity weakness and spasticity.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hepatic-myelopathy-as-a-rare-neurological-complication-of-cirrhosis-a-case-report/