Central pontine myelinolysis with stupor alone after orthotopic liver transplantation

Central pontine myelinolysis (CPM) after orthotopic liver transplantation is frequently diagnosed at autopsy. Its actual prevalence is unknown. We reviewed 386 orthotopic liver transplantations performed at the Mayo Clinic, Rochester, MN, including 39 with autopsy reports. CPM developed in four patients (1%) (found using magnetic resonance imaging in two, at autopsy in two). All four patients lacked typical signs and symptoms of CPM (pseudobulbar palsy and quadriplegia) but had stupor as the main presenting feature. When perioperative plasma osmolality and serum sodium values were compared with those values in patients with transient metabolic encephalopathy but no CPM at autopsy, no consistent association was observed, and values differed greatly. We conclude that CPM in orthotopic liver transplantation frequently is manifested by altered levels of consciousness alone, mimicking metabolic encephalopathy.