Diagnosis And Treatment Of Central Pontine Myelinolysis After Liver Transplantation: A Report Of Five Cases

ObjectiveBased on the latest documents,The clinical data of five cases of central pontine myelinolysis(CPM)after liver transplantation in our hospital were analyzed retrospectively.It provides a sound basis to discuss and summarize the causes, mechanism,diagnosis and future possible treatment of CPM after liver transplantation.MethodsThe clinical data of five cases of CPM after liver transplantation were analyzed retrospectively:Preoperative condition:the diagnosis,the function of liver and kidney and the complication.The information of operation:total time for operation,the amount of hemorrhage,fluid replacement and the fluctution degree of serum level before and after operation within 24 hours.Postoperative condition: normal situation after operation,blood immunodepressant concentration,the time when CPM occured,the first symptom of each patient,the therapeutic methods and the prognosis of them,ect.ResultsOne patient carried Wilson's disease,who had a good hepatic function before operation,and the operation was well done.Three patients were Severe hepatitis, two of which had the complication of hepatic encephalopathy and hepatorenal syndrome with chronic obstinate hyponatremia.Both of the later two cases had rapid correction of hyponatremia in 24 hours(20～30mmol/L)The other one had a history of alimentary tract hemorrhage before the operation,it took long time for the operation with a large amount of hemorrhage,however,no obvious change for hyponatremia after operation.The diagnosis of the last patient was Budd-Chiari syndrome with Child-B hepatic function,and a large amount of hemorrhage during the operation(14500ml).Symptoms started on the 9th,7th,5th,10th,13th day after transplantation respectively.The first two cases had the symptom of aphasia,while the other three cases had headache,facial palsy and anisocoria.Diagnosis was established by magnetic resonance image(MRI)for the five patients.After aggressive symptomatic management,support,corticoid and plasmapheresis,one was healed, one recovered his myodynamia with the Babinski sign becoming negative,however, with a sequalla of speaking slowly.one suffered from sequela of facial palsy,myodynamia attenuate and disability to walk without support.One remained to be dysarthria and Babinski sign positive,however,he could take care of himself,one died in the end because of multiple organ failure through a long time coma after operation.Conclusion1.Liver transplantation is a high risk factor of CPM.There are many pathophysiologic factors that facilitates CPM:such as malnutrition, over-increasing of serum level after operation,brain damage caused by ischemia-reperfusion injury of liver,neurotoxicity of immunosuppressant,ect.2.Much attention should be paied to the patients with complication of hepatic encephalopathy,hepatorenal syndrome,chronic obstinate hyponatremia,there's a big possibility of facilitating CPM after operation for them.Precaution is the key point.3.The clinical manifestations of CPM are diversity,Early diagnosis of CPM depends on clinical vigilance and MRI to avoid the careless and false diagnosis.4.It is crucial to be precautious for CPM,the good function rectification of liver and kidney,good control of hepatic encephalopathy and alimentary tract hemorrhage before operation.the least amount of hemorrhage during operation,the steady correction of hyponatremi after operation play a key role to prevent CPM.5.The key point of curing CPM is to prevent and treat the complication caused by CPM:infections of bellows and unity passage,bedsore,amyotrophy of disuse,and so on.