Hepatic Encephalopathy in Liver Cirrhosis with Rapidly Progressing Spastic Paraparesis (Hepatic Myelopathy)

Clinical Scenario

This protocol addresses hepatic encephalopathy occurring in the context of liver cirrhosis complicated by hepatic myelopathy — a rare neurological complication characterised by rapidly progressing spastic paraparesis without sensory deficit or sphincter dysfunction.

Condition

Hepatic myelopathy is a rare complication of cirrhosis, most often associated with extensive portosystemic shunts. Its hallmark is a rapid motor deterioration — lower-limb spasticity and paraparesis — that does not respond to standard therapies for hepatic encephalopathy, making this a distinct and urgent clinical situation.

Treatment Approach

Given the absence of effective conventional therapies for this condition, the approach involves a specific surgical intervention that should be considered promptly in eligible patients.

The complete protocol — including full eligibility criteria, timing, and clinical guidance — is available via the link below.