Oral Presentations - Pathology and Laboratory Medicine - University ...

ResidentAbstract # 2Ahmad Al-SarrafAhmad J. Al-Sarraf MD 1 , Mazhar Haque MB BS, FRACP 2 , Morris Pudek BSc, PhD 3 ,Eric M. Yoshida, MD, MHSc, FRCP(C) 21Department of Pathology and Laboratory medicine, Faculty of medicine, UBC 2 Departmentof Medicine, Division of Gastroenterology, UBC and BC Transplant 3 Department of Pathology& Laboratory Medicine, VGHcentral pontine myelinolysis following orthotopicliver transplantation- a rare complicationBackround/ObjectivesOrthotopic liver transplantation (OLT) is the treatment of choice for many acute and chronic end-stage liverdiseases as well as selected cases of primary liver malignancy. With the increased number of OLT, some neurologicalcomplications have become apparent. Central pontine myelinolysis (CPM) is a rare and severe neurologicalcomplication characterized by acute central pontine neuronal demyelination along with severe occasionally irreversiblemanifestations. We report a patient diagnosed with CPM following OLT in the absence of significant hyponatremia.We suggest that several factors may contribute to the development of CPM following OLT.MethodsA 46-year-old female patient underwent orthotopic liver transplantation due to end stage decompensated cryptogeniccirrhosis with hepatic encephalopathy. Post transplant period was complicated with renal impairment. Later, shedeveloped hepatic artery thrombosis and lost her graft. However, clinically she was neurologically unremarkable. Sheunderwent a second transplant a month after the initial one. postoperatively, she developed neurologic symptomscharacteristics of CPM and MRI showed changes compatible with CPM with no dramatic changes in sodium plasmalevel.ConclusionCentral pontine myelinolysis has a multifactor aetiology. Slow correction of hyponatremia is crucial for the preventionof CPM, but attention should be given to the group of patients with higher risk factors such as liver transplantations,alcoholism, and malnutrition. It should be kept in mind that CPM can affect patients with low, normal, or elevatedserum levels of sodium.12 2 0 1 0 * O r a l P r e s e n t a t i o n s