Spinal cord involvement in patients with cirrhosis

Raffaele Nardone*, Yvonne Höller, Monica Storti, Piergiorgio Lochner, Frediano Tezzon, Stefan Golaszewski, Francesco Brigo, Eugen Trinka

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)2578-2585
Number of pages8
JournalWorld Journal of Gastroenterology
Issue number10
Publication statusPublished - 14 Mar 2014
Externally publishedYes

Other keywords

  • Chronic liver disease
  • Cirrhosis
  • Endovascular procedures
  • Hepatic myelopathy
  • Liver transplantation
  • Porto-systemic shunt
  • Spastic paraparesis


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