DOI: 10.12890/2026_006582

Hepatic myelopathy as a rare but reversible neurological complication post transjugular intrahepatic portosystemic shunt (TIPS) insertion in liver cirrhosis

Authors

  • Angela Zhu Department of Gastroenterology, Alfred Health, Melbourne, Australia 0009-0008-7817-9545
  • Warren Clements Department of Radiology, Alfred Health, Melbourne, Australi; Department of Surgery, Monash University School of Translational Medicine, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia 0000-0003-1859-5850
  • Robb Wesselingh Department of Neurosciences, Alfred Health, Melbourne, Australia; Department of Neurosciences, School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia 0000-0002-5898-3287
  • Natasha Janko Department of Gastroenterology, Alfred Health, Melbourne, Australia; Department of Radiology, Alfred Health, Melbourne, Australia

angzhu26@gmail.com

Keywords

Hepatic myelopathy, liver cirrhosis, portal hypertension, transjugular intrahepatic portosystemic shunt

Abstract

Hepatic myelopathy is a rare but underrecognized complication of chronic liver disease characterized by pure motor, symmetric and spastic paraparesis without sphincter involvement. We report the case of a 39-year-old female with Child Pugh A alcohol-related cirrhosis presenting with progressive spastic paraparesis 2 months after transjugular intrahepatic portosystemic shunt (TIPS) placement for recurrent oesophageal variceal bleed. TIPS occlusion achieved partial neurological recovery but significant functional improvement. She had no further presentations of decompensation with variceal bleeding or hepatic encephalopathy. Early recognition and multidisciplinary input are essential in preserving functional outcome, especially when liver transplant is not indicated.

View the entire article

Downloads

References

  1. Weissenborn K, Tietge UJ, Bokemeyer M, Mohammadi B, Bode U, Manns MP, et al. Liver transplantation improves hepatic myelopathy: evidence by three cases. Gastroenterology 2003;124:346-351. doi: 10.1053/gast.2003.50062
  2. Ma FQ, Huang J, Li WZ, Li PJ, Liu MY, Shi W, et al. [Effects of reduced portosystemic flow on hepatic myelopathy in patients with cirrhosis after TIPS]. Zhonghua Gan Zang Bing Za Zhi 2022 Oct;30:1063-1068. Chinese. doi: 10.3760/cma.j.cn501113-20201026-00580
  3. Nardone R, Höller Y, Storti M, Lochner P, Tezzon F, Golaszewski S, et al. Spinal cord involvement in patients with cirrhosis. World J Gastroenterol 2014;20:2578-2585. doi: 10.3748/wjg.v20.i10.2578
  4. Mendoza G, Marti-Fàbregas J, Kulisevsky J, Escartín A. Hepatic myelopathy: a rare complication of portacaval shunt. Eur Neurol 1994;34:209-212. doi: 10.1159/000117040
  5. Lim CG, Hahm MH, Lee HJ. Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review. J Yeungnam Med Sci 2023;40:136-145. doi: 10.12701/jyms.2022.00689
  6. Kori P, Sahu R, Jaiswal A, Shukla R. Hepatic myelopathy: an unusual neurological complication of chronic liver disease presenting as quadriparesis. BMJ Case Rep 2013;2013:bcr2013009078. doi: 10.1136/bcr-2013-009078
  7. Ren S, Lv Y, Wang Z, Bai M, Zhang W, Niu J, et al. Hepatic myelopathy after transjugular intrahepatic portosystemic shunt: prevalence, risk factors, and long-term outcome. J Hepatol 2016;64:S262
  8. Zhao H, Liu F, Yue Z, Wang L, Fan Z. Evaluation of mid- and long-term efficacy of shunt limiting for hepatic myelopathy after transjugular intrahepatic portosystemic shunt. Clin Res Hepatol Gastroenterol 2016;40:440–446. doi: 10.1016/j.clinre.2015.11.004
  9. Zhu Z, Liu Y, Wu W, et al. Liver transplantation reverses hepatic myelopathy in hepatitis B-related decompensated liver cirrhosis: case report and review of the literature. Transplant Proc 2022;54:158–160. doi: 10.1016/j.transproceed.2021.11.016
  10. Sun L, Li J, Lan LL, Li XA. The effect of fecal microbiota transplantation on hepatic myelopathy. Medicine (Baltimore) 2019;98:e16430. doi: 10.1097/md.0000000000016430

Published

2026-05-06

Issue

Vol. 13 No. 5 (2026)

Categories

How to Cite

1.
Zhu A, Clements W, Wesselingh R, Janko N. Hepatic myelopathy as a rare but reversible neurological complication post transjugular intrahepatic portosystemic shunt (TIPS) insertion in liver cirrhosis. EJCRIM [Internet]. 2026 May 6 [cited 2026 Nov. 3];13(5). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6582