Hotson J R, Enzmann D R
Department of Neurology, Stanford University School of Medicine, California.
Neurol Clin. 1988 May;6(2):349-65.
The neurologic evaluation of an individual cardiac transplant recipient often does not lead to a succinct bedside diagnosis. There are few consistent clinical observations. The onset of seizures in the early postoperative period is associated with embolic cerebral infarction. Seizures occur most commonly, however, as a neurotoxic manifestation of cyclosporine. The onset of an acute delirium or psychosis in the first week after cardiac transplantation usually has multiple causative factors and is reversible. A postoperative brachial plexopathy or mononeuropathy can be identified with a neurologic examination, confirmed by appropriate electrophysiologic testing and is usually reversible. The onset of periorbital inflammation, ophthalmoplegia, and nasal turbinate or sinus invasion and necrosis is consistent with phycomycosis. Most patients, however, present with nonspecific findings of impaired mentation with or without focal neurologic signs. These patients require a fairly systematic search for potentially treatable neurologic complications (see Table 3). In a medically stable patient an aggressive diagnostic approach, at times including stereotaxic brain aspirate or biopsy, is indicated. In the severely ill patient with multiple organ failure, empirical therapy for the most probable treatable disorder is justified.
对个体心脏移植受者进行神经学评估往往无法得出简洁明了的床旁诊断结果。一致的临床观察结果很少。术后早期癫痫发作与栓塞性脑梗死有关。然而，癫痫发作最常见的原因是环孢素的神经毒性表现。心脏移植后第一周出现的急性谵妄或精神病通常有多种致病因素，且是可逆的。术后臂丛神经病变或单神经病可通过神经学检查发现，经适当的电生理测试证实，且通常是可逆的。眶周炎症、眼肌麻痹以及鼻甲或鼻窦侵犯和坏死的出现与毛霉菌病相符。然而，大多数患者表现为精神状态受损的非特异性表现，伴有或不伴有局灶性神经体征。这些患者需要相当系统地寻找潜在可治疗的神经并发症（见表3）。对于病情稳定的患者，有时需要采取积极的诊断方法，包括立体定向脑穿刺抽吸或活检。对于患有多器官功能衰竭的重症患者，针对最可能可治疗的疾病进行经验性治疗是合理的。
