Neurologic Complications

It is reported that between 19 and 47 percent of all adult liver transplant patients have a neurologic complication at some time during their posttransplant course. Neurologic complications in children, however, are much less common (8 percent).14 Common presenting problems include headache, seizure, and mental status changes. The etiology is more likely to be noninfectious than infectious. Common noninfectious etiologies are hemorrhage, immunosuppressive toxicity, and metabolic derangement. Central nervous system (CNS) infection is most common in the first few months, with viral and fungal etiologies predominating. CNS CMV infection is rare and CNS herpesvirus infection is seen with the same frequency as in the general population. Bacterial etiologies include Listeria, Klebsiella, S. aureus, Nocardia, and Escherichia coli. Aspergillus, Candida, and Cryptococcus sp. are the more common fungal agents involved. Cryptococcal disease is most common between 2 and 7 months.16 Patients presenting with headache, seizures, or mental status changes need to evaluated for the presence of metabolic derangement as well as hemorrhage or infection. They will often require computed tomography (CT) of the head and lumbar puncture to rule out these etiologies. 12 Neuropathic pain may be seen and is poorly responsive to opioids. It may respond to tricyclic antidepressants. 16

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