الفهرس 
ANATOMY OF THE SPINAL CORDOnly 14 pages are availabe for public view
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Abstract
Hepatic myelopathy is a neurological complication of chronic liver disease with portal hypertension. It is related to porto-caval shunt that has been created surgically or has occurred spontaneously. The pathogenesis of hepatic myelopathy is poorly understood, although it is usually thought that nitrogenous products bypassing the liver through the porto-caval shunt play an important role. In most of the reported cases, episodes of overt hepatic encephalopathy have preceded the development of the myelopathy. The pathology of hepatic myelopathy consists mainly of symmetrical demyelination of the lateral pyramidal tracts, and is sometimes associated with axonal loss, generally going no higher than cervical cord level. The patients with hepatic myelopathy usually have spastic paraparesis or deep tendon reflexes changes without sphincter or sensorial involvement. There is no specific diagnostic tool for diagnosis of hepatic myelopathy. Therefore, the other reasons of paraparesis must be excluded. The technique of transcranial magnetic stimulation (TMS) to study motor circuits has made it possible to investigate ”none invasively” central motor pathways conduction in human. It is used to evaluate the reliability of the motor evoked potentials (MEPs) elicited by TMS in detecting the functional involvement of the spinal cord in patients with hepatic myelopathy. There have been case reports of transplantation being used with varying degrees of success in improving the myelopathic changes, anyhow if liver transplantation has a role in the management of this condition, one need to bear the underlying pathology in mind.