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SHUNT ENCEPHALOMYELOPATHY. II. OCCURRENCE OF PERMANENT MYELOPATHY*
- LESLIE ZIEVE, M.D., F.A.C.P.;
- DAVID F. MENDELSON, M.D.†; and
- MARY GOEPFERT, M.D.Minneapolis, Minnesota
- Requests for reprints should be addressed to Leslie Zieve, M.D., Veterans Administration Hospital, Minneapolis 17, Minnesota.
Excerpt
The reversible acute or chronic recurrent neurologic signs associated with hepatic coma, Eck's fistula, or an extensive portal collateral circulation are well known. So is the coexistence of permanent hepatic and nervous system abnormalities in hepatolenticular degeneration. However, the occurrence of nontransient neurologic findings in isolated patients with liver disease, exclusive of Wilson's disease, has not been so widely appreciated. Little emphasis has been placed upon the development of focal neurologic manifestations, particularly of the spinal cord, though a few instances have been recorded in the literature. Moreover, clinical neuropathologic correlations have been exceedingly scant. Our observation recently of two
This 100-word excerpt has been provided in the absence of an abstract.
Summario in Interlingua
Le occurrentia de permanente paraplegia spastic es describite in le casos de duo patientes con cirrhosis qui habeva repetite episodios de coma proteinic post gastrectomia in combination con shunting porto-caval. Dismyelination del tractos pyramidal in le medulla dorsal sed non in le cerebro esseva demonstrate in le prime del duo casos. Duo altere documentate casos de patientes con dismyelination in le medulla dorsal in association con shunting porto-general esseva trovate in le curso de un scrutinio del litteratura, sed in ambe iste casos le patientes manifestava degeneration hepato-lenticular in ultra de lor alterationes de medulla dorsal, sed non morbo de Wilson.
Ambe nostre patientes habeva marcate grados de sensibilitate proteinic. Isto progredeva in le curso del tempore, e depletion del proteina del corpore e atrophia esseva inevitabile. Il es probabile que le gastrectomia ageva primarimente como un intensificator del effectos de shunting porto-caval. Es opinate que le lesion del medulla dorsal es un effecto metabolic del un o del altere producto del decomposition de proteina que es ordinarimente eliminate o modificate per le hepate sed que in casos del typo hic considerate non attinge le cellulas hepatic.
Le essayo de categorisar le varie syndromes neuropsychiatric que occurre in association con shunting porto-general o morbo hepatic resultava in le combination del numerose variantes in quatro gruppos major. Istos es le casos de encephalomyelopathia (1) acute, (2) acute recurrente, (3) chronic recurrente, e (4) chronic permanente.
Article and Author Information
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↵* Received for publication October 14, 1959.
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From the Departments of Medicine and Neurology and the Radioisotope Service, Veterans Administration Hospital, University of Minnesota, Minneapolis, Minnesota.
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