Hepatic Myelopathy: A Rare Complication of Chronic Liver Failure Treated Conservatively Without Liver Transplantation

Hepatic myelopathy (HM) diagnosis requires the exclusion of other causes of spastic paraparesis and typically presents in the setting of recurrent hepatic encephalopathy. Pathophysiology involves toxin accumulation, particularly ammonia, leading to astrocyte swelling and demyelination of the corticospinal tract. While nonpyramidal symptoms can be reversible with treatment, spastic paraparesis may not always respond. Liver transplant is considered a definitive treatment, but outcomes vary. Early intervention and monitoring of ammonia levels in patients with known portosystemic shunts may reduce irreversible HM cases. Recognizing HM in patients with spastic paraparesis and liver disease is crucial for timely intervention and potentially reversing symptoms.