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Recovery of locked-in syndrome following liver transplantation with calcineurin inhibitor cessation and supportive treatment.
[locked-in syndrome]
Locked-
in
syndrome
represents
the
most
severe
form
of
central
pontine
myelinolysis
(
CPM
)
and
has
been
associated
with
a
dismal
outcome
.
In
this
report
we
describe
a
case
of
severe
locked-
in
syndrome
after
liver
transplantation
with
spontaneous
recovery
with
cessation
of
calcneurin
inhibitor
therapy
and
supportive
treatment
.
A
54
-
year
old
male
received
deceased-donor
liver
transplantation
and
developed
decreased
level
of
consciousness
with
spastic
quadriplegia
.
A
diagnosis
of
central
pontine
myelinolysis
with
extrapontine
manifestations
was
confirmed
by
magnetic
resonance
imaging
.
His
immunosuppresion
was
modified
by
switching
from
tacrolimus
to
sirolimus
and
addition
of
prednisone
.
The
patient
started
to
recover
from
symptoms
fourth
months
after
transplantation
.
Tacrolimus
is
known
to
have
neurotoxic
side
effects
and
it
may
precipitate
CPM
in
patients
who
have
predisposing
factors
.
Sirolimus
and
steroids
should
be
considered
as
safe
and
an
effective
alternative
for
immunosuppression
in
the
setting
of
CPM
after
liver
transplantation
.
