Central pontine myelinolysis in liver transplantation.

Abstract

Gross external findings were determined at necropsy and the brains then fixed whole by suspension in 10% formalin for three to six weeks before slicing. In the 47 cases collected prospectively the brain stem and cerebellum were detached and the cerebrum sliced coronally at one cm intervals. Any grossly obvious lesions were sampled for histological examination. Routinely, blocks were also taken from frontal, temporal, parietal and occipital lobes, hippocampus, basal ganglia, thalamus, cerebellum and medulla. The pons was carefully examined for evidence of CPM and blocks taken at mid-pontine level. In cases where the clincal history suggested pontine disease or where there was evidence of CPM in the first block, additional blocks were taken to include rostral and caudal pons. In three cases only single random blocks of pons were available for study.The tissue was processed to paraffin wax using a standard technique and sections were cut and stained with haematoxylin and eosin and luxol fast blue. In cases where initial sections were suspect for CPM, immunohistochemical stains for glial fibrillary acidic protein (GFAP) and neurofilament protein were prepared using an indirect immunoperoxidase technique,30 and further blocks of tissue were stained with oil red 0 to detect neutral fat.All clinical records were carefully scrutinised and particular note was made of neurological features and serum sodium changes in both the periods before and after transplantation.

Complicaciones neurológicas en pacientes adultos sometidos a trasplante hepático ortotópico: Experiencia de un centro universitario

“…Una serie de 50 pacientes fallecidos posterior a THO fueron sometidos a estudio neuropatológico, cinco tenían MP que no fue diagnosticada previamente 39 . No se observó una correlación directa entre cambios bruscos de la concentración de sodio plasmático y la aparición de MP 39 .…”

“…No se observó una correlación directa entre cambios bruscos de la concentración de sodio plasmático y la aparición de MP 39 . Yu et al comunicaron una incidencia de MP de 3,5%, encontrando en algunos casos una hiponatremia previa al THO 40 .…”

Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study

“…9,20 One study found patients with a pre-operative SNa 5130 mmol/L were more likely to undergo a rapid intra-operative increases in SNa. 27 Boon et al 28 described five cases of previously undiagnosed myelinolysis among 50 post-mortem examinations of patients who died following LTx. Four of these patients had a rapid peri-operative increase in SNa, of whom three had a pre-operative SNa 5133 mmol/L.…”

Structural neuroimaging and neuropsychological correlates of a single case of focal central pontine myelinolysis: Intact memory function with decreased intellectual and motor functions

“…Some evidence suggests that cyclosporine, an immunosuppressive agent, may be causally related in transplant patients with CPM [11,12]. Liver transplant patients also account for the vast majority of childhood cases of CPM, for which no causal explanation has been supported thus far [13]. Hence, dysregulation of sodium ion metabolism and concomitant neurotoxicity of brain cells within the central pons appears to play a key role in most hypothesizing about the etiology of this disorder.…”