Central pontine myelinolysis after liver transplantation: is sodium the only villain? Case report.
OBJECTIVE
Critically ill patients frequently develop neurologic symptoms, which frequently become a clinical challenge. Described approximately 50 years ago, pontine neuronal demyelination is a pathologic change associated with neurologic and psychiatric problems after liver transplantation. The objective of this report was to present a case of central pontine myelinolysis diagnosed after liver transplantation and to discuss its pathophysiology.


METHODS
A 29 years old female patient underwent liver transplantation for fulminant hepatic failure. Postoperatively, she developed neurologic symptoms characteristic of the Locked In Syndrome and the MRI showed changes compatible with central pontine myelinolysis. The patient did not develop dramatic changes in sodium plasma levels, which is frequently incriminated as the causal agent, and improved considerably within a few weeks.


CONCLUSIONS
The etiology of central pontine myelinolysis is multifactorial, and special attention should be given to the group of patients at greater risk, such as those with sudden changes in the plasma levels of sodium, liver transplantation, chronic alcoholics, and malnourished. It is important to recognize that osmotic demyelination can develop in patients with low, normal, or elevated plasma levels of sodium, indicating the contribution of other trigger factors.
de Morais
Bruno Salomé
BS
Anestesiologista do Hospital Lifecenter e do Grupo de Transplante de Orgãos do HC/UFMG. brunomoraisanet@yahoo.com.br
Carneiro
Fabiano Soares
FS
Araújo
Rodolfo de Morais
Rde M
Araújo
Guilherme Freitas
GF
de Oliveira
Rodrigo Bernardes
RB
D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D017590:Myelinolysis, Central Pontine / Q000097:blood / Q000209:etiology* / Q000378:metabolism*; D012964:Sodium / Q000097:blood / Q000378:metabolism*
D012964:Sodium