Novel interventional approach shows success in treating hepatic myelopathy, rare liver disease complication

A case report published on July 28, 2026, describes a 42-year-old cirrhosis patient with post-TIPS hepatic myelopathy who achieved significant recovery after embolization of a paraspinal vein shunt. While liver transplantation is the only established cure for this rare, debilitating neurological complication, this novel interventional radiology approach successfully restored the patient's independent mobility, suggesting that venous hypertension rather than toxicity may drive the disease.

Post-TIPS hepatic myelopathy case

• ▪The 42-year-old patient presented with progressive lower limb weakness, recurrent hepatic encephalopathy, pancytopenia, hypoalbuminaemia, hyperbilirubinaemia, and hyperammonaemia.
• ▪A 42-year-old man with cirrhosis developed progressive spastic paraplegia four years after receiving a transjugular intrahepatic portosystemic shunt for recurrent variceal bleeding.

Paraspinal vein shunt embolization

• ▪Embolization of a gastro-renal shunt alone failed to improve the patient's gait, but subsequent embolization of the paraspinal vein shunt led to substantial recovery.
• ▪Clinicians embolized a previously unrecognized paraspinal vein shunt connecting the left renal vein to the paraspinal and ascending lumbar veins in the patient.

Hepatic myelopathy pathogenesis mechanisms

• ▪Hepatic myelopathy is a rare neurological complication of chronic liver disease characterized by progressive spastic paraparesis of the lower limbs without significant sensory impairment.
• ▪The case suggests that venous hypertension and mechanical spinal cord compression by varicose veins, rather than portal toxicity, may drive hepatic myelopathy pathogenesis.

Progressive spastic paraparesis recovery

• ▪Following paraspinal vein shunt embolization, the patient regained the ability to walk independently 3 to 4 miles daily, with recovery sustained at 12 months.
• ▪The patient's lower limb strength improved from flaccid paralysis to near-normal strength, and spasticity decreased significantly following the paraspinal vein shunt embolization.

Interventional alternatives to transplantation

• ▪Embolization of portosystemic shunts, such as the paraspinal vein shunt, offers a potential interventional radiology alternative for patients ineligible for liver transplantation.
• ▪Liver transplantation is historically considered the only curative treatment for hepatic myelopathy, which is otherwise considered incurable.

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