THE NEUROLOGICAL COMPLICATIONS OF CARDIAC TRANSPLANTATION

摘要: Review of the neurological complications encountered in 83 patients who received cardiac homografts over a seven-year period leads to following conclusions: (1) Neurological disorders are common transplant recipients, occurring 50 per cent patients. (2) Infection was single most frequent cause dysfunction, being responsible for one-third all CNS complications. (3) The infective organisms were typically those considered be usually low pathogenicity: fungi, viruses, protozoa and an uncommon bacterial strain. (4) Other clinical syndromes related vascular lesions, often apparently from cerebral ischaemia or infarction during surgical procedure, metabolic encephalopathies, microglioma, acute psychotic episodes back pain vertebral compression fractures. (5) infectious probably development neoplasms de novo, immunosuppressive therapy which impairs virtually host defence mechanisms alters nature host's response agents other foreign antigens. (6) Because symptoms signs behavioural changes deterioration intellectual performance, examination little value diagnosing even anatomical site neuropathological process. (7) possibility origin manifestations must aggressively pursued absence fever significantly abnormal spinal fluid examination. diagnostic error made frequently ascribe erroneously disturbances "intensive care unit psychosis" when they fact due unrecognized infection. (8) Maintenance mean cardiopulmonary bypass pressures above 70 mmHg, particularly with known arteriosclerosis, may reduce operative morbidity. (9) Though increased accuracy is possible routine use variety radiological laboratory techniques, two further requirements met before significant reduction frequency will occur: advent greater immunospecificity suppressing rejection grafted organ while preserving defences against infection; more effective armamentarium antiviral antifungal drugs.