Mielinolisis central pontina en trasplante hepático

Background: Central Pontine Myelinolysis (CPM) is the most severe neurological complication after liver transplantation and apparently is not related to changes in osmolarity. Aim: To report five transplanted patients with CPM. Patients and Methods: In a series of 27 patients subjected to liver tran...

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Autores principales:	CARTIER R,LUIS, ARMIJO M,JOSÉ, QUIROZ Z,GONZALO, MATAMALA C,JOSÉ MANUEL
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2010
Materias:	Encephalopathy hepatic Liver transplantation Myelinolysis central
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100009
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spelling	oai:scielo:S0034-988720100011000092011-01-10Mielinolisis central pontina en trasplante hepáticoCARTIER R,LUISARMIJO M,JOSÉQUIROZ Z,GONZALOMATAMALA C,JOSÉ MANUEL Encephalopathy hepatic Liver transplantation Myelinolysis central Background: Central Pontine Myelinolysis (CPM) is the most severe neurological complication after liver transplantation and apparently is not related to changes in osmolarity. Aim: To report five transplanted patients with CPM. Patients and Methods: In a series of 27 patients subjected to liver transplantation between 2005 and 2008, we found five patients who developed CPM. Results: All patients presented a severe hepatic encephalopathy. In the absence of alterations in osmolality, they developed, between the second to seventh day after transplantation, a central quadriplegia, hyperreflexia and Babinski sign, with preservation of sensorium. Magnetic resonance imaging showed demyelination of the motor pathway only in the protuberance. Motor recovery first began in the fingers and hands, followed by forearms, toes, feet, arms and finally the legs, defining a somatotopic recovery of the cortico-spinal pathway. Conclusions: This form of regaining motility shows that the selective involvement of the pyramidal tract in CPM, is according to its location in the pons and suggests a local entrapment. It is due to the structural rigidity of the protuberance that limits the expansive requirements of cytotoxic and vasogenic edema, and only affects the long fibers of cortico-spinal tracts, sensitized by encephalopathy. The entrapment syndromes generally preserve the axons, injure myelin and have no inflammatory reactions.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.138 n.10 20102010-10-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100009es10.4067/S0034-98872010001100009
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Encephalopathy hepatic Liver transplantation Myelinolysis central
spellingShingle	Encephalopathy hepatic Liver transplantation Myelinolysis central CARTIER R,LUIS ARMIJO M,JOSÉ QUIROZ Z,GONZALO MATAMALA C,JOSÉ MANUEL Mielinolisis central pontina en trasplante hepático
description	Background: Central Pontine Myelinolysis (CPM) is the most severe neurological complication after liver transplantation and apparently is not related to changes in osmolarity. Aim: To report five transplanted patients with CPM. Patients and Methods: In a series of 27 patients subjected to liver transplantation between 2005 and 2008, we found five patients who developed CPM. Results: All patients presented a severe hepatic encephalopathy. In the absence of alterations in osmolality, they developed, between the second to seventh day after transplantation, a central quadriplegia, hyperreflexia and Babinski sign, with preservation of sensorium. Magnetic resonance imaging showed demyelination of the motor pathway only in the protuberance. Motor recovery first began in the fingers and hands, followed by forearms, toes, feet, arms and finally the legs, defining a somatotopic recovery of the cortico-spinal pathway. Conclusions: This form of regaining motility shows that the selective involvement of the pyramidal tract in CPM, is according to its location in the pons and suggests a local entrapment. It is due to the structural rigidity of the protuberance that limits the expansive requirements of cytotoxic and vasogenic edema, and only affects the long fibers of cortico-spinal tracts, sensitized by encephalopathy. The entrapment syndromes generally preserve the axons, injure myelin and have no inflammatory reactions.
author	CARTIER R,LUIS ARMIJO M,JOSÉ QUIROZ Z,GONZALO MATAMALA C,JOSÉ MANUEL
author_facet	CARTIER R,LUIS ARMIJO M,JOSÉ QUIROZ Z,GONZALO MATAMALA C,JOSÉ MANUEL
author_sort	CARTIER R,LUIS
title	Mielinolisis central pontina en trasplante hepático
title_short	Mielinolisis central pontina en trasplante hepático
title_full	Mielinolisis central pontina en trasplante hepático
title_fullStr	Mielinolisis central pontina en trasplante hepático
title_full_unstemmed	Mielinolisis central pontina en trasplante hepático
title_sort	mielinolisis central pontina en trasplante hepático
publisher	Sociedad Médica de Santiago
publishDate	2010
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100009
work_keys_str_mv	AT cartierrluis mielinolisiscentralpontinaentrasplantehepatico AT armijomjose mielinolisiscentralpontinaentrasplantehepatico AT quirozzgonzalo mielinolisiscentralpontinaentrasplantehepatico AT matamalacjosemanuel mielinolisiscentralpontinaentrasplantehepatico
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Mielinolisis central pontina en trasplante hepático

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