Portal-systemic myelopathy after transjugular intrahepatic portosystemic shunt creation: Report of four cases

The authors attempted to describe the clinical manifestations of portal-sys temic myelopathy (PSM) after transjugular intrahepatic portosystemic shunt (TIPS) creation. PSM was developed in four of 212 (1.89%) patients who unde rwent TIPS procedures in our hospital. Three men and one woman, ranging in age from 41 to 56 years, with a history of posthepatitis cirrhosis and recu rrent bleeding from gastroesophageal varices had intrahepatic shunts create d with 10-mm-diameter Wallstents. Shunt patency was confirmed by color Dopp ler ultrasonography (US) in each patient after TIPS creation. Progressive s pastic paraparesis involving the lower extremities occurred between 5 weeks and 5 months after TIPS creation in the four patients. Neurologic examinat ion showed evidence of spasticity in all cases, with ankle clonus, extensor plantar responses, and lower extremity hyperreflexia. All sensory modaliti es remained intact. Cytologic examination of cerebrospinal fluid from each patient was normal. There was no evidence of spinal cord compression on the imaging studies. PSM is a rare syndrome that includes spastic paraparesis with intact sensation. Initially noted in patients who have undergone surgi cal placement of a portacaval shunt, it also may occur after TIPS creation.