Spontaneous Remission Of Hepatic Myelopathy In A Patient With Alcoholic Cirrhosis: A Case Report
Chang, C. Y., Liu, C., Duan, F. F., Zhai, H., Song, S. S., & Yang, S. (2022). Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report. World journal of clinical cases, 10(30), 11172–11177. https://doi.org/10.12998/wjcc.v10.i30.11172
View Original Source →Abstract
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.
Case Details
Disease Location
Nervous system
Personal Characteristics
53-year-old man with alcoholic cirrhosis. History of gastroesophageal variceal bleeding and received splenectomy combined with a gastroesophageal devascularization surgery
Clinical Characteristics
Admitted for lower extremity weakness, slow movement, and a stumbling gait that required walking assistance with a crutch. Contrast abdominal computed tomography revealed liver cirrhosis, esophageal and gastric varices, gastro-left renal shunt, and portal vein thrombosis. Magnetic resonance imaging (MRI) of the brain indicated hyperintensities in the bilateral globus pallidus. The patient was diagnosed with hepatic myelopathy (hm). The patient chose abstinence and took furosemide, spironolactone, lactulose, l-ornithine-l-aspartate
Remission Characteristics
The symptoms of hm resolved gradually after 2 years of treatment. All complications of alcoholic cirrhosis resolved after 4 years of follow-up.
Treatment & Mechanisms
Proposed Remission Mechanisms
Self-resolving hm might be possible after relief of the underlying liver disease.
Clinical Treatment
Furosemide, spironolactone, lactulose, l-ornithine-l-aspartate
Non-Clinical Treatment
Alcohol abstinence