Central pontine myelinolysis after liver transplant: A case report and an updated review
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, a...
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| Published in: | Saudi journal of anaesthesia Vol. 17; no. 2; pp. 275 - 277 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
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India
Medknow Publications and Media Pvt. Ltd
01-04-2023
Medknow Publications & Media Pvt. Ltd Wolters Kluwer - Medknow Wolters Kluwer Medknow Publications |
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| Abstract | 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. |
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| AbstractList | 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. |
| Audience | Academic |
| Author | Delgado, Marina Ayres Machado Oliveira, Maurício Vitor Henrique Torres Menezes, Pedro Biagio Murta E Di Flora, Francisco |
| AuthorAffiliation | Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil |
| AuthorAffiliation_xml | – name: Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil |
| Author_xml | – sequence: 1 givenname: Francisco surname: Biagio Murta E Di Flora fullname: Biagio Murta E Di Flora, Francisco organization: Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil – sequence: 2 givenname: Maurício Vitor surname: Machado Oliveira fullname: Machado Oliveira, Maurício Vitor organization: Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil – sequence: 3 givenname: Pedro surname: Henrique Torres Menezes fullname: Henrique Torres Menezes, Pedro organization: Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil – sequence: 4 givenname: Marina Ayres surname: Delgado fullname: Delgado, Marina Ayres organization: Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37260634$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/j.jceh.2021.07.011 10.1097/TP.0000000000000496 10.1136/bcr-2013-203516 10.1111/petr.12255 10.1016/j.transproceed.2020.01.144 10.1111/ajt.14317 |
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| Copyright | Copyright: © 2023 Saudi Journal of Anesthesia. COPYRIGHT 2023 Medknow Publications and Media Pvt. Ltd. 2023. This article is published under (http://creativecommons.org/licenses/by-nc-sa/3.0/) (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright: © 2023 Saudi Journal of Anesthesia 2023 |
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| Keywords | Anesthesia central pontine myelinolysis hyponatremia liver transplantation |
| Language | English |
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| References | Crismale (R10-25-20240909) 2017; 17 Wang (R9-25-20240909) 2020; 52 Lambeck (R4-25-20240909) 2019; 116 Jahan (R6-25-20240909) 2020; 12 Patel (R7-25-20240909) 2022; 12 Siddiqui (R2-25-20240909) 2018; 10 Crivellin (R3-25-20240909) 2015; 99 Uchida (R5-25-20240909) 2014; 18 Mascarenhas (R1-25-20240909) 2014; 2014 Rebedew (R8-25-20240909) 2016; 115 |
| References_xml | – volume: 12 start-page: e8209 year: 2020 ident: R6-25-20240909 article-title: Osmotic demyelination syndrome despite appropriate hyponatremia correction publication-title: Cureus contributor: fullname: Jahan – volume: 12 start-page: 714 year: 2022 ident: R7-25-20240909 article-title: Tacrolimus-induced central pontine myelinolysis in a pediatric liver transplant recipient publication-title: J Clin Exp Hepatol doi: 10.1016/j.jceh.2021.07.011 contributor: fullname: Patel – volume: 10 start-page: e3252 year: 2018 ident: R2-25-20240909 article-title: Normal correction of sodium leading to central pontine demyelinosis: A rare occurrence publication-title: Cureus contributor: fullname: Siddiqui – volume: 115 start-page: 326 year: 2016 ident: R8-25-20240909 article-title: Is central pontine myelinolysis reversible? publication-title: Wis Med J contributor: fullname: Rebedew – volume: 99 start-page: 1257 year: 2015 ident: R3-25-20240909 article-title: Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: A single-center study publication-title: Transplantation doi: 10.1097/TP.0000000000000496 contributor: fullname: Crivellin – volume: 116 start-page: 600 year: 2019 ident: R4-25-20240909 article-title: Central pontine myelinosis and osmotic demyelination syndrome publication-title: Dtsch Arztebl Int contributor: fullname: Lambeck – volume: 2014 start-page: bcr2013203516 year: 2014 ident: R1-25-20240909 article-title: Central pontine myelinolysis: Electrolytes and beyond publication-title: BMJ Case Rep doi: 10.1136/bcr-2013-203516 contributor: fullname: Mascarenhas – volume: 18 start-page: 18 year: 2014 ident: R5-25-20240909 article-title: Central pontine myelinolysis following pediatric living donor liver transplantation: A case report and review of literature publication-title: Pediatr Transplant doi: 10.1111/petr.12255 contributor: fullname: Uchida – volume: 52 start-page: 1798 year: 2020 ident: R9-25-20240909 article-title: Anesthetic fluid management of patients with hyponatremia undergoing living donor liver transplantation publication-title: Transplant Proc doi: 10.1016/j.transproceed.2020.01.144 contributor: fullname: Wang – volume: 17 start-page: 2537 year: 2017 ident: R10-25-20240909 article-title: Prevention of the osmotic demyelination syndrome after liver transplantation: A multidisciplinary perspective publication-title: Am J Transplant doi: 10.1111/ajt.14317 contributor: fullname: Crismale |
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| SubjectTerms | Anesthesia Case Report Case reports central pontine myelinolysis hyponatremia Liver liver transplantation Liver transplants Sufentanil Transplantation |
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| Title | Central pontine myelinolysis after liver transplant: A case report and an updated review |
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