Osmotic demyelination syndrome after liver transplantation: A case report and an updated review

Osmotic demyelination syndrome (ODS) is a rare condition marked by demyelination of brain tissue due to degeneration and loss of oligodendrocytes. It is classified into central pontine myelinolysis and extrapontine myelinolysis based on the lesion sites. Diagnosis and treatment are often delayed due to inadequate clinical recognition. This study aims to examine the causes, diagnosis, and treatment experiences of ODS post liver transplantation (LT). The case of a 67-year-old female patient who underwent LT for chronic acute liver failure and primary biliary cirrhosis is retrospectively analyzed. Following her transfer to the intensive care unit, the development of ODS was monitored. Symptoms appeared on the second day after LT, beginning with muscle loss in the limbs. This was followed by localized twitching in the left upper limb and bilateral lower limb twitching, along with tremors in the head and face, lethargy, binocular fixation, facial paralysis, aphasia, and coma. ODS was confirmed through head magnetic resonance imaging, and the patient died 40 days post operation. LT and electrolyte disturbances are significant risk factors for ODS. Various pathophysiological factors influence its onset and progression during the perioperative period, necessitating prioritized prevention. Its clinical presentations are diverse, and enhancing clinical vigilance and timely diagnostic evaluations are crucial for early diagnosis of ODS.