Central pontine myelinolysis after liver transplant: A case report and an updated review

• Published in: Saudi journal of anaesthesia Vol. 17; no. 2; pp. 275 - 277
• Main Authors: Biagio Murta E Di Flora, Francisco, Machado Oliveira, Maurício Vitor, Henrique Torres Menezes, Pedro, Delgado, Marina Ayres
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-04-2023; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Anesthesia; Case Report; Case reports; central pontine myelinolysis; hyponatremia; Liver; liver transplantation; Liver transplants; Sufentanil; Transplantation; Anesthesia; central pontine myelinolysis; hyponatremia; liver transplantation
• ISSN: 1658-354X; 0975-3125
• DOI: 10.4103/sja.sja_709_22

Based on brain magnetic resonance imaging results, the second and third most frequent causes of central pontine myelinolysis (CPM) were liver transplant (LT) and cirrhosis, which together accounted for 13.7% and 12.5% of all diagnoses of CPM. Medical diseases including cirrhosis, LT, malnutrition, and alcoholism are well-known conditions associated with CPM in addition to hyponatremia. The prognosis is poor and depends on early diagnosis and treatment to achieve better outcomes. This is a case report of CPM occurring after a deceased donor LT in a patient presenting many risk factors such as chronic hyponatremia, previous episodes of encephalopathy, and tacrolimus immunosuppression. We briefly discuss the pathophysiology, risk factors, diagnosis, and treatment, highlighting the role and challenges of the anesthesiologist in managing this kind of patient and preventing the syndrome in the context of major surgery.