[Reversible hepatic myelopathy: a case report]

Area of Science:

• Neurology
• Hepatology
• Gastroenterology

Background:

• Alcoholic liver cirrhosis can lead to hepatic myelopathy, a neurological complication.
• Hepatic myelopathy symptoms include gait disturbances and sensory deficits.
• Traditionally, liver transplantation is considered the primary treatment for hepatic myelopathy.

Observation:

• A 42-year-old female with alcoholic liver cirrhosis presented with spastic gait and lower extremity sensory issues.
• Elevated serum ammonia and abnormal tibial somatosensory evoked potentials (SEP) supported the diagnosis.
• Other causes of myelopathy were excluded.

Findings:

• Ammonia-lowering therapy with lactulose was administered orally.
• The patient showed significant improvement in spastic gait.
• Tibial SEP abnormalities resolved, with N30 and P38 potentials emerging post-treatment.

Implications:

• This case suggests that ammonia-lowering therapy is a viable treatment option for early-stage hepatic myelopathy.
• Early intervention with lactulose may prevent the progression of neurological deficits.
• This finding offers a less invasive therapeutic alternative to liver transplantation in select cases.