Central Nervous System Syndromes in Solid Organ Transplant Recipients

Solid organ transplant recipients frequently manifest central nervous system (CNS) symptoms. Infection, metabolic abnormalities, malignancies, vascular events, and drug effects may contribute to CNS syndromes. Clinical symptoms are often poor guides to specific processes. Specific etiologic diagnoses should be pursued. Solid organ transplant recipients have a high incidence of central nervous system (CNS) complications, including both focal and diffuse neurologic deficits. In the immunocompromised host, the initial clinical evaluation must focus on both life-threatening CNS infections and vascular or anatomic lesions. The clinical signs and symptoms of CNS processes are modified by the immunosuppression required to prevent graft rejection. In this population, these etiologies often coexist with drug toxicities and metabolic abnormalities that complicate the development of a specific approach to clinical management. This review assesses the multiple risk factors for CNS processes in solid organ transplant recipients and establishes a timeline to assist in the evaluation and management of these complex patients.