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NEUROLOGY 1989;39:493
© 1989 American Academy of Neurology

Central pontine myelinolysis after liver transplantation

Conrado J. Estol, MD, Amin A. Faris, MD, A. Julio Martinez, MD and Mamdouha Ahdab-Barmada, MD

Neurology Department, Presbyterian-University Hospital and University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs. Estol and Faris)
Pathology Department, Neuropathology Division, Presbyterian-University Hospital and University of Pittsburgh School of Medicine, Pittsburgh, PA (Dr. Martinez)
Neurology Department, Veterans Administration Hospital, Neuropathology Division, Children's Hospital of Pittsburgh, Pittsburgh, PA (Dr. Faris)
Pathology Department, Neuropathology Division, Children's Hospital of Pittsburgh, Pittsburgh, PA (Dr. Ahdab-Barmada).

Eight adults and 3 children out of 85 patients who had neuropathologic examination after death following orthotopic liver transplantation showed central pontine myelinolysis (CPM). Four patients also had extrapontine myelinolysis. Eight patients had significant serum sodium changes. In 5, the fluctuation occurred perioperatively and 4 had a clinical picture consistent with CPM, although no patient had this as an antemortem diagnosis. We emphasize the role of hepatic dysfunction as a cause of CPM and recommend careful monitoring of electrolytes in the perioperative period of patients undergoing liver transplantation.

Address correspondence and reprint requests to Dr. Estol, Neurology Department, Tufts University, New England Medical Center Hospitals, 750 Washington Street, Boston, MA 02111.

Received May 10, 1988. Accepted for publication in final form October 14, 1988.




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