Permanent Paraplegia With Cirrhosis

Chronic, fluctuating neuropsychiatric disorder is a recognized complication of cirrhosis of the liver associated with an extensive portal collateral circulation, having been reported when portal-systemic anastomoses develop spontaneously¹or when portal-systemic shunts have been created surgically for portal hypertension.²The clinical and electroencephalographic (EEG) changes in such patients are characteristically reversed by restriction of dietary protein and administration of antibiotics.^3,4More recently, Zieve and associates⁵described permanent paraplegia with demyelination of the pyramidal tracts of the spinal cord in a patient with cirrhosis following portacaval anastomosis. Reference was made to an earlier report of encephalopathy and paraplegia in a patient with cirrhosis and extensive portal-systemic collateral vessels.⁶Subsequently, three additional instances of apparently irreversible neuropsychiatric disorder associated with cirrhosis have been reported, two following shunt operations and another developing spontaneously,^7,8thus supporting a causal relationship between the conditions. The present paper (1) describes a