Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation.

Abstract

In a recent series of 44 liver transplants we identified both extrapontine myelinolysis (EPM) - characteristic of cyclosporine neurotoxicity - and central pontine myelinolysis (CPM) in 5 recipients posttransplant. An additional 2 recipients had EPM only posttransplant. MRIs performed in 4 asymptomatic recipients were normal. Large perioperative shifts in serum sodium, hypomagnesemia, and high cyclosporine levels may play a role in the development of these lesions, although the evidence from this study is inconclusive. In addition to supportive care, dilantin was started in patients who had seizures; aggressive magnesium replacement was initiated for hypomagnesemia, and cyclosporine levels were reduced in all patients. All patients demonstrated a slow steady recovery and all but 2 are at home at the time of writing. CPM may be more prevalent than previously appreciated following liver transplantation, although its prognosis may not be as dismal.

• Authors: J P Fryer, M V Fortier, P Metrakos, D J Verran, S K Asfar, D M Pelz, W J Wall, D R Grant, C N Ghent
• Journal: Transplantation (Transplantation) Vol. 61 Issue 4 Pg. 658-61 (Feb 27 1996) ISSN: 0041-1337 [Print] United States
• PMID: 8610399 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Immunosuppressive Agents
• Cyclosporine
• Cholesterol
• Sodium
• Magnesium

Topics

• Adult
• Aged
• Cholesterol (blood)
• Cyclosporine (adverse effects, therapeutic use)
• Demyelinating Diseases (etiology)
• Electroencephalography
• Female
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Liver Transplantation (adverse effects)
• Magnesium (blood)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Myelinolysis, Central Pontine (blood, chemically induced, etiology)
• Pons (drug effects, pathology)
• Sodium (blood)