Subclinical central pontine myelinolysis after liver transplantation.

A 17-year-old boy was diagnosed with Wilson’s disease, with end-stage liver cirrhosis for 5 years. The major indication for LRLT was repeated esophageal variceal bleeding, which needed sclerotherapy and/or banding (eight times between February 1996 and December 1998). A brain magnetic resonance imaging (MRI) was done (one of the workup tests in transplant candidates with Wilson’s disease) which showed a symmetric hyperintensity signal in the bilateral globus pallidus on T1-weighted image. The globus pallidus MRI result may have been due to portosystemic shunting or the paramagnetic effect of copper or iron deposition. The brainstem at this time was unremarkable (Fig 1A). LRLT was performed on January 14, 1999. The operation was without complications and the patient recovered uneventfully. However, ascites developed and hypoalbuminemia persisted in the postoperative period despite