[Central pontine myelinolysis associated with cyclosporin in liver transplantation].
Liver transplant is the only effective treatment in the terminal liver disease. However, the complexity of the surgical technique and immunosuppression cause many neurologic complications. Three liver transplant recipients treated with cyclosporine developed a reversible neurologic syndrome characterized by early dysarthria, which evolved to anarthria, and tetraparesis. Brain MRI disclosed hyperintense lesions, on T2, and proton density-weighted images, in basis pontis. The substitution of the cyclosporine for FK 506, or its reduction, led to the clinical improvement of the patients. Therefore, cyclosporine may cause central pontine myelinolysis, being dysarthria the first manifestation of neurotoxicity. The early recognition of speech disorders in liver transplant recipients that receive cyclosporine should prompt withdrawal of the drug to avoid possible neurological sequelae. Furthermore, the strict control of natremias before and after the transplant may help to reduce the incidence of this type of complications, since a synergyc osmotic mechanism cannot be ruled out.
Rodríguez
J
J
Servicio de Neurología, Hospital Virgen del Prado, Talavera de la Reina, Toledo.
Benito-León
J
J
Molina
J A
JA
Ramos
A
A
Bermejo
F
F
D000328:Adult; D000368:Aged; D003524:Cyclosporins / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000139:chemically induced* / Q000473:pathology
D003524:Cyclosporins; D004791:Enzyme Inhibitors