Hepatic Myelopathy as a Rare but Reversible Neurological Complication Post Transjugular Intrahepatic Portosystemic Shunt (TIPS) Insertion in Liver Cirrhosis.

Hepatic myelopathy is a rare but underrecognized complication of chronic liver disease characterized by pure motor, symmetric and spastic paraparesis without sphincter involvement. We report the case of a 39-year-old female with Child Pugh A alcohol-related cirrhosis presenting with progressive spastic paraparesis 2 months after transjugular intrahepatic portosystemic shunt (TIPS) placement for recurrent oesophageal variceal bleed. TIPS occlusion achieved partial neurological recovery but significant functional improvement. She had no further presentations of decompensation with variceal bleeding or hepatic encephalopathy. Early recognition and multidisciplinary input are essential in preserving functional outcome, especially when liver transplant is not indicated. LEARNING POINTS: The onset of symmetric, pure motor spastic paraparesis following a transjugular intrahepatic portosystemic shunt procedure in cirrhosis should prompt clinical suspicion for hepatic myelopathy.Hepatic myelopathy can be reversible with timely shunt occlusion/modification, especially when a liver transplant is not indicated.Recognizing liver cirrhosis as a systemic syndrome and adopting early multi-disciplinary input improve patient outcomes.