Clinical features of hepatic myelopathy in patients with chronic liver disease.

Aim: To determine the clinical features of hepatic myelopathy (HM), a rare condition associated with chronic liver disease (CLD), in patients in the city of Harbin, China.

Methods: The medical files of 13 patients with HM were selected from 500 randomly chosen files of CLD patients registered in four Harbin hospitals. General information on all cases was summarised and clinical features were compared between HM positive patients (HM group) and HM negative CLD patients (control group). Detailed analysis of the clinical characteristics of HM positive patients was undertaken.

Results: The patients in the HM group ranged in age from 41-50 years, which did not differ significantly from the control group. However, the sex ratio in the HM group (12 males/1 female) was significantly higher (p<0.05) than in the control group (342 males/145 females).The most frequent underlying aetiology was post type B hepatitis (12 cases). All cases in the HM group had a history of relapsing hepatic encephalopathy (HE) before or after HM onset, and showed electroencephalographic (EEG) abnormalities; however, the results of spinal cord magnetic resonance imaging were negative, and cerebrospinal fluid analysis findings were normal. Except for clinical manifestations of bilateral lower limb spastic paralysis, the two groups did not differ significantly in regard to other symptoms or signs. Hypoproteinaemia (positive predictive value (PPV) 5.69%, negative predictive value (NPV) 99.65%), blood ammonia elevation (PPV 5.29%, NPV, 99.32%) and abnormal EEG (PPV 5.00%, NPV 100.00%) were sensitive and specific for HM diagnosis.

Conclusion: In Harbin, HM is found mainly among middle aged men with CLD caused by viral hepatitis and accompanied by relapsing onset of HE. Bilateral lower limb spastic paralysis with hypoproteinaemia, blood ammonia elevation and/or abnormal EEG are significant diagnostic indicators of HM.