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Case report
Spastic paraparesis associated with advanced liver cirrhosis: a condition obscure in terms of treatment and prognosis
  1. Jaspreet Kaur,
  2. Gautam Jesrani,
  3. Monica Gupta and
  4. Sarabmeet Singh Lehl
  1. General Medicine, Government Medical College and Hospital, Chandigarh, India
  1. Correspondence to Professor Monica Gupta; monicamanish2001{at}


Hepatic myelopathy or spastic paraparesis of liver disease is an insidious onset condition with pure motor spastic paraparesis without sensory, bladder or bowel involvement in patients with chronic liver disease, in which the neurological dysfunction cannot be explained by other causes. It is a rare, relentlessly progressive and mostly irreversible neurological complication resulting from portosystemic shunts occurring spontaneously, created surgically or due to ‘functional shunting’. In some cases, no evidence of shunting is elicitable due to difficulty in locating the hidden collaterals. We report this rare case of a 33-year-old man with chronic liver disease presenting with spastic paraparesis after 11 months of resolution of an episode of hepatic encephalopathy.

  • alcoholic liver disease
  • cirrhosis
  • spinal cord

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  • Contributors All the authors have provided substantial contributions in the clinical management of the case and literature review on the topic in question. JK and GJ have drafted the manuscript and MG and SSL have revised it critically for important intellectual content. All the authors have read the final version and approved it. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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