Korean J Anesthesiol.  1997 Sep;33(3):572-577. 10.4097/kjae.1997.33.3.572.

Central Pontine Myelinolysis after Liver Transplantation: A case report

• Lee KJ
• Choi H
• Yoon YJ
• Kim ST

• KMID: 2091176
• DOI: http://doi.org/10.4097/kjae.1997.33.3.572

Abstract

Central pontine myelinolysis (CPM) is a demyelinating disorder that almost exclusively affects the central portion of basis pontis and occurs in patients with malnutrition, chronic debilitating disorders and electrolyte abnormalities. CPM after liver transplantation is considered that had the relationship to rapid correction of hyponatremia and shift in osmolality. Our first case of 4 liver transplantations altered consciousness at the 5th day after transplantation and did not recover fully until 14 months. At first, atrial fibrillation and atelectasis due to left main broncheal obstruction were thought the causes of impaired consciousness as postoperative hypoxic event. At that time, CT scan showed diffuse brain atropy that suggested previous hepatic encephalopathy and/or hypoxic ischemic encephalopathy. After that, MRI revealed CPM and diffuse cortical atropy. We concluded that CPM associated with rapid correction of hyponatremia perioperatively alter patient's consciousness with hypoxic brain injury.

Keyword

Brain, central pontine myelinolysis; Ions, hyponatremia; Transplantations, liver

MeSH Terms

Atrial Fibrillation
Brain
Brain Injuries
Consciousness
Demyelinating Diseases
Hepatic Encephalopathy
Humans
Hyponatremia
Hypoxia-Ischemia, Brain
Liver Transplantation*
Liver*
Magnetic Resonance Imaging
Malnutrition
Myelinolysis, Central Pontine*
Osmolar Concentration
Pulmonary Atelectasis
Tomography, X-Ray Computed