Subclinical central pontine myelinolysis following liver transplantation

  title={Subclinical central pontine myelinolysis following liver transplantation},
  author={Takeo Kato and Haruo Hattori and Masako Nagato and Tetsuya Kiuchi and Shinji Uemoto and Tatsutoshi Nakahata and Koichi Tanaka},
  journal={Brain and Development},
Central pontine myelinolysis (CPM) is a demyelinating disorder of unknown origin that almost exclusively affects the central portion of the basis pontis, and is one of the fatal neurological complications after liver transplantation. We describe two children with CPM detected incidentally after liver transplantation. To our knowledge, this is the first report of CPM diagnosed antemortem in children who had undergone liver transplantation. In our patients, there were no clinical manifestations… Expand
Central pontine and extrapontine myelinolysis: a rare and fatal complication after liver transplantation.
The aim of this paper was to report the experience with CPEM among LT patients and find no abnormalities were detected in immunosuppressive drug blood levels. Expand
Central pontine myelinolysis following pediatric living donor liver transplantation: A case report and review of literature
MRI is proposed to be promptly considered for patients with abnormal neurological findings, together with the substitution of CNI with an mTOR inhibitor as a management regimen for CNI‐related CPM. Expand
Central pontine myelinolysis central pontine myelinolysis manifesting with massive myoclonus.
This report presents the first infantile case of central pontine myelinolysis manifesting with massive myoclonus, a 17-month-old patient with kwashiorkor and hyponatremia who developed acute massive myOClonus. Expand
A case of asymptomatic pontine myelinolysis
A 69-year-old Caucasian male presented intensive headache and underwent cranial MRI that showed the typical feature of central pontine myelinolysis, and the possible role in the etiopathogenesis of his chronic use of anti-depressive drugs and exposure to glue and chemical agents is discussed. Expand
Occult central pontine myelinolysis post liver transplant: A consequence of pre-transplant hyponatremia.
An adult patient who presented as post-op delirium, had incidental finding of CPM by magnetic resonance imaging of the head after a liver transplant, despite his non-typical presentation, had the typical risk factors of C PM such as chronic hyponatremia, rapid overcorrection of serum sodium and cirrhosis undergoing a transplant. Expand
Possible causes of central pontine myelinolysis after liver transplantation.
The occurance of CPM may be associated with such factors as hyponatremia, rapid rise of serum sodium concentration, plasma osmolality increase postoperation, the duration of operation, and high CsA levels. Expand
[The possible causes of central pontine myelinolysis after liver transplantation].
The occurrence of CPM may be associated with hyponatremia, rapid rise of serum sodium concentration, postoperative increase of plasma osmolality, the duration of operation and high CsA levels. Expand
Risk Factors for Central Pontine and Extrapontine Myelinolysis following Orthotopic Liver Transplantation
CPM/EPM after OLT is more likely to occur in patients with more severe preoperative Liver Disease-Na score, preoperative hyponatremia and hypocholesterolemia, as well as greater changes in electrolytes, especially sodium, during surgery. Expand
Mielinólise pontina central e extra-pontina em paciente alcoolista sem distúrbios hidro-eletrolíticos: relato de caso
The case of a 39 year-old man with severe alcoholism, who presented with spastic tetraparesis and palsy of several cranial nerves, associated with lesions in the magnetic resonance compatible with CPM/EPM is reported. Expand
Identifying Risk Factors for Central Pontine and Extrapontine Myelinolysis After Liver Transplantation: A Case–Control Study
High MELD score patients undergoing OLT, receiving massive perfusions of Na-rich products, experiencing surgery-related hemorrhagic complication and important fluctuations of Na are at risk of developing CPEPM. Expand


Central pontine myelinolysis after liver transplantation
The role of hepatic dysfunction as a cause of CPM is emphasized and careful monitoring of electrolytes in the perioperative period of patients undergoing liver transplantation is recommended. Expand
Central pontine myelinolysis in liver transplantation.
There is a high incidence of central pontine myelinolysis after liver transplantation, that clinical diagnosis is difficult, and that there is no simple direct correlation between rapid serum sodium changes and the development of this condition. Expand
Mild central pontine myelinolysis: a frequently undetected syndrome
It is reasonable that the incidence of comparatively mild forms of CPM as well as extrapontine manifestations are more frequent than hitherto assumed and the clinical outcome of the syndrome is better than expected from earlier fatal case reports and is quite independent of the extent of the lesion as it appears with brain imaging methods. Expand
Hyponatremia and central pontine myeIinolysis
It is suggested that the possibility of central pontine myelinolysis be considered in any patient with hyponatremia and neurologic dysfunction. Expand
Behavioral manifestations of central pontine myelinolysis.
A young woman with a clinical history and magnetic resonance imaging scan consistent with central pontine myelinolysis came to medical attention because of prominent behavioral symptoms. MarkedExpand
Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients.
Three, perhaps four, cases were observed in which the myelin sheaths of all the nerve fibers in the central part of the basis pontis had been destroyed in a single, large, symmetric focus, leading to death in about 13 and 26 days. Expand
Central pontine myelinolysis in severely burned patients
It is concluded that severely burned patients, like alcoholics, are especially susceptible to CPM, and that in burn patients with CPM there is a striking association with serum hyperosmolality. Expand
A hypothesis of osmotic endothelial injury. A pathogenetic mechanism in central pontine myelinolysis.
It is proposed that the rapid rise in the serum sodium level causes an osmotic injury to the endothelium resulting in the release of myelinotoxic factors and/or the production of vasogenic edema, which may lead to demyelination. Expand
Neuropathology of pediatric liver transplantation.
Only with continued observation after surgery combined with rapid medical and surgical treatment can it be hoped to improve the prognosis following liver transplantation in the pediatric population. Expand
Central nervous system lesions in liver transplant recipients: prospective assessment of indications for biopsy and implications for management.
A presumptive etiologic diagnosis can be established in a vast majority of CNS lesions in liver transplant recipients based on identifiable presentation that includes time of onset, unique risk factors, and neuroimaging characteristics. Expand