Portosystemic Shunt Presenting as Spastic Paraparesis in a Patient with Non-Cirrhotic Portal Hypertension

Background and Aim: Portosystemic myelopathy (PSM) is a rare complication in patients with portosystemic shunts, manifesting as pure motor spastic paraparesis. Case Report: We present case of PSM patient non-cirrhotic portal hypertension (NCPH). A 55-year-old female presented difficulty walking followed by progressive stiffness both lower limbs for 6 months. There was no involvement upper limbs. Physical examination revealed moderate splenomegaly. She had spasticity (grade 3) brisk knee ankle jerks bilateral extensor plantar response (Babinski sign). were cerebellar signs sensory normal. Higher mental functions cranial nerve Laboratory investigations showed pancytopenia, normal INR, hypoalbuminemia, elevated plasma ammonia, low serum creatine kinase, vitamin B12 folate levels. Cerebrospinal fluid conduction study Autoimmune encephalitis, immunoline, paraneoplastic panel negative. MRI whole spine screening brain mild global cortical atrophy. Contrast enhanced CT scan abdomen dilated vein (17.5 mm) tortuous porto-systemic collaterals noted the paraduodenal right suprarenal regions draining into renal vein. Liver Spleen grossly enlarged (21 cm). diagnosis paraparesis due to portocaval shunting considered. treated intrathecal baclofen physiotherapy. Mild improvement observed. an irreversible refractory condition affecting spinal cord usually presenting limb sparing Conclusion: The clinical should be established after exclusion other common entities spiral cord. Selective embolization or surgical occlusion shunt can halt disease progression and, some cases reverse early stages.