CENTRAL PONTINE MYELINOLYSIS AFTER LIVER-TRANSPLANTATION - A CASE-REPORT

A patient development deteriorating mental status, quadriparesis, and severe pseudobulbar palsy with the inability to speak or swallow follo wing orthotopic liver transplantation (OLT), Subsequently, abnormaliti es were found in the pens on MRI that were consistent with central pon tine myelinolysis (CPM). Marked recovery occurred following transfer t o the rehabilitation medicine service. Seven months following developm ent of CPM, a mild dysarthria has persisted, but full ambulation has r eturned. Although no significant fluctuations in serum sodium were see n perioperatively, multiple risk factors associated with the developme nt of CPM were present, including end-stage liver disease, a history o f alcohol abuse, malnutrition, hypoxia, and use of cyclosporin medicat ion postoperatively. This case demonstrates that the development of CP M may occur following OLT despite meticulous attention to serum sodium concentrations. We conclude that CPM is multifactorial in nature. The re can be a great variation in its clinical course.