Abstract
Neurologic complications are common and potential serious complications after hematopoietic stem cell transplant (HSCT). Metabolic abnormalities, neurotoxic drugs, opportunistic infections, and hematologic toxicities make the HSCT population high risk for developing neurologic complications. There should be a low clinical suspicion for thoroughly investigating any neurologic symptoms even up to a year after transplant and regardless of risk factors. Though deficits are often reversible, early detection and discontinuing the offending agent (if drug induced) and appropriate treatment are critical. This chapter reviews presenting symptoms, diagnostic evaluation, and treatment recommendation for common neurologic complications.
The reported incidence of neurologic complications after HSCT varies widely from 10 to 40 %. Neurologic complications are commonly serious and associated with a poor prognosis. In general, risks of neurologic complications are higher in patients undergoing allogeneic HSCT.
Risk for neurologic complications is highest in the first few months after HSCT, though the risk persists even to 1 year. Multiple risk factors have been suggested. Metabolic disarray, use of neurotoxic drugs, systemic HSCT complications, and opportunistic infections make the HSCT population high risk for developing neurologic complications.
Development of neurologic symptoms during the HSCT process warrants a thorough neurologic investigation. When a neurologic process is suspected, the following should be considered:
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A thorough history to define duration of symptoms.
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2.
Identification of prior exposure to potentially neurotoxic agents
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3.
A neurologic examination to identify focal deficits and, if present, prompt urgent imaging to assess for mass lesion.
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4.
An electroencephalogram (EEG) should be performed in the setting of persistent fluctuations in mental status to evaluate for nonconvulsive status epilepticus.
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5.
If infection is suspected and no contraindications are detected on neuroimaging or hematology laboratories, a lumbar puncture (LP) should be performed.
This chapter reviews the common neurologic complications encountered after HSCT, presenting symptoms, diagnostic evaluation, and management.
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Summary
Summary
Neurologic complications post-HSCT are common, difficult to identify early in the treatment course, and portend a worse outcome. Clinicians caring for this population should have a low clinical suspicion for thoroughly investigating any neurologic symptoms even up to a year after transplant and regardless of risk factors. Though deficits are often reversible, early detection and discontinuing the offending agent (if drug induced) and appropriate treatment are critical.
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Taylor, J., Schiff, D. (2015). Neurologic Complications. In: Maziarz, R., Slater, S. (eds) Blood and Marrow Transplant Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-13832-9_25
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DOI: https://doi.org/10.1007/978-3-319-13832-9_25
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