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Updated: Oct 20, 2025
08:56
Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults
Published on: November 7, 2014
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Clinical Reasoning: A Middle-aged Man With Progressive Gait Abnormalities
Junyu Lin1, Yanbing Hou1, Huifang Shang2
1From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Neurology
|September 10, 2021
Summary
Acquired causes of progressive spastic paraplegia, particularly treatable ones like hepatic myelopathy, must be ruled out. This case highlights a patient with spastic paraplegia, ataxia, and parkinsonism due to liver disease.
Area of Science:
- Neurology
- Hepatology
- Radiology
Background:
- Hereditary spastic paraplegias (HSPs) cause progressive spastic paraplegia via corticospinal tract degeneration.
- Acquired causes, including metabolic and iatrogenic factors, can mimic HSP symptoms.
Observation:
- A middle-aged man presented with progressive spastic paraplegia, ataxia, and parkinsonism.
- Brain MRI revealed basal ganglia and cerebellar hyperintensities with susceptibility-weighted imaging hypointensity.
- Elevated blood ammonia and diffuse slow-wave EEG activity were noted.
Findings:
- The patient had a history of hypertension, alcoholic liver cirrhosis, and a transjugular intrahepatic portosystemic shunt.
- Diagnosis was acquired hepatocerebral degeneration and hepatic myelopathy, excluding HSP gene mutations.
Implications:
- This case underscores the importance of considering and excluding acquired, potentially curable, causes of spastic paraplegia.
- A comprehensive diagnostic approach is crucial for differentiating HSPs from other etiologies presenting with similar neurological deficits.
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