Central pontine myelinolysis after liver transplantation. Report of five cases 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.
Introducción: Los pacientes con tinnitus y audición normal son poco frecuentes. No hay referencias en la literatura sobre los hallazgos del examen vestibular en este tipo de enfermos. Objetivo: Analizar los hallazgos de la exploración clínica cocleo-vestibular en un grupo de pacientes con tinnitus y audición (audiometría tonal clásica) normal. Material y método: Estudio retrospectivo de un grupo de 17 pacientes con tinnitus y audición normal examinados en un período de 10 años; sus resultados se compararon con los de un grupo control de 17 sujetos sin tinnitus y con audición normal. Resultados: En el grupo de pacientes la audiometría tonal clásica era normal y en el examen vestibular la mayoría de ellos (15) mostró una paresia vestibular unilateral en la prueba calórica; en sólo dos ésta era normal. En marcado contraste con el grupo de pacientes, en la mayoría de los sujetos normales (15) la prueba calórica era normal y en 2 se encontró una paresia vestibular unilateral. Conclusión: Se formula la hipótesis que, en nuestro grupo de pacientes, el tinnitus sería el único síntoma de una lesión "subclínica" cocleo-vestibular, la cual en la exploración cocleo-vestibular se manifestaría sólo por una paresia vestibular.
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