Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Reversible hepatic myelopathy: a case report

Daisuke Hirozawa, M.D.1), Kei Fukada, M.D., Ph.D.1), Takahide Yaegaki, M.D.1), Taku Hoshi, M.D., Ph.D.1), Jinichi Sawada, M.D.1) and Takanori Hazama, M.D.1

1)Department of Neurology, Osaka General Medical Center

We report a case of reversible hepatic myelopathy. A 42-year-old female patient with 3-year history of alcoholic liver cirrhosis developed spastic gait, hyperreflexia and mild somatosensory disturbance in her lower extremities. The increased level of serum ammonia and the deficits of N30 and P38 in the tibial somatosensory evoked potentials (SEP) in conjunction with exclusion of the other known causes of myelopathy supported the diagnosis of her hepatic myelopathy. The ammonia lowering therapy by the oral administration of lactulose successfully improved the spastic gait accompanied with the emergence of N30 and P38 in the tibial SEP. Although liver transplantation was known to be the only therapy for hepatic myelopathy in the literatures, our case showed that the ammonia lowering therapy can be effective for the early stage of hepatic myelopathy.
Full Text of this Article in Japanese PDF (1993K)

(CLINICA NEUROL, 54: 223|226, 2014)
key words: hepatic myelopathy, somatosensory evoked potentials, lactulose, liver transplantation, hyperammonemia

(Received: 19-Feb-13)