A Case Report Of Alcoholic Cirrhosis With Hepatic Myelopathy And Review Of The Literature

Objective: The aim is to discuss the epidemiological trends,pathogenesis,pathological characteristics,clinical manifestation,laboratory and ancillary examinations,diagnosis method,treatments and prognostic factors of the hepatic myelopathy(HM),through analyzing typical case of alcoholic cirrhosis with HM,which to improve the understanding,diagnosis and treatment level of HM.Method: This report retrospectively analyzed the clinical data of a typical patient with alcoholic cirrhosis with HM,combined with literature reports at home and abroad,discuss the epidemiological trends,pathogenesis,diagnosis methods,treatments and prognostic factors of the HM.Results: The patient,male,39 year-old,had a history of heavy drinking,reported intermittent hematemesis,melena,and disturbance of consciousness for 2 years,weakness of both lower limbs for 1 year,and aggravation for 1 week.Physical examination showed the muscle strength V(-),increased muscle tension,symmetrically hyperactive tendon reflex of both legs,and the patient exhibited scissors gait when he walked,plasma ammonia level was 124?mol/L.Clinical diagnosis: alcoholic cirrhosis with HM.Treatment:after comprehensive treatment of department of medicine such as protecting liver,removing jaundice and using diuretic,however the patient' s lower extremity asthenia behaved no significant improvement.Moreover,through out-of-hospital follow-up for One and a half years,there was slow progression of lower extremity asthenia in the patient,and then classic non-bypass orthotopic liver transplantation(OLT)was performed in department of hepatobiliary surgery of our hospital.Postoperative follow-up to present,the muscle strength of both lower limbs recovered,and the patient's condition improved.Conclusion: The disease in the patient gradually developed into portal hypertension,opening portal-lumen collateral circulation and esophagealgastro-varices on the basis of alcoholic cirrhosis,showing recurrent upper gastrointestinal bleeding and hepatic encephalopathy.With the prolongation of time,the disease evolved into hepatic myelopathy,which seriously affected the daily life of the patient.However,conservative medical treatment was not satisfactory at this stage;and after liver transplantation,symptom of weakness of both lower extremities in the patient was alleviated.According to this case,we conclude that HM may be related to portal collateral circulation formation,the elevation of plasma ammonia level and the deficiency of neurotrophic substances.HM mainly exhibites slowly progressive spastic paraplegia of both lower limbs without sphincter and sensory disorders,which poorly responds to internal medicine treatment;and early liver transplantation may improve the long-term prognosis of patients suffering hepatic myelopathy.