Reversible symmetric polyneuropathy with paraplegia after heart transplantation
| Autor: | Ioannis Terrovitis, Antonios K. Rombos, George Tolis, Serafim Nanas, John N. Nanas |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
medicine.medical_specialty
Side effect Lidocaine medicine.medical_treatment Neurological disorder Liver transplantation Postoperative Complications medicine Humans Heart transplantation Paraplegia Postoperative Care Transplantation Dose-Response Relationship Drug business.industry Electromyography Peripheral Nervous System Diseases Dilated cardiomyopathy Middle Aged medicine.disease Surgery Anesthesia Cyclosporine Heart Transplantation Female business Polyneuropathy Immunosuppressive Agents medicine.drug |
| Zdroj: | Transplantation. 65(10) |
| ISSN: | 0041-1337 |
| Popis: | Background. Neurotoxicity is a well-recognized side effect of cyclosporine therapy in transplant recipients. Cyclosporine can cause a wide range of adverse effects on both the central and peripheral nervous systems. Methods. We present a case history of symmetric polyneuropathy with flaccid paraplegia, a rare neurological complication of cyclosporine administration. Results. Blood levels of the drug above the therapeutic range accompanied the neurological manifestations. The syndrome subsided fully with dose reduction. Patients’ symptoms were attributed to axonal degeneration of the peripheral nerves, according to electromyography findings. Conclusions. Cyclosporine neurotoxicity should always be considered in patients with neurological complications following transplantation. The case presented in this article illustrates an additional potential mechanism of this adverse effect, namely, axonal degeneration of the peripheral nerves, causing symmetric polyneuropathy. The use of cyclosporine as the main immunosuppressive agent has substantially increased survival after marrow and solid organ transplantation. Among the various adverse effects, nephrotoxicity is the most significant (1).Neurotoxicity, although well-recognized, is rare and usually mild and reversible. There are several reports of cyclosporine-associated neurotoxicity after marrow, kidney, and liver transplantation, and a limited number of instances of this particular side effect have been observed after heart and heart-lung transplantation in recent years (2-10). However, to our knowledge, there have been no reported cases of symmetric polyneuropathy after heart transplantation. We report one patient who underwent heart transplantation and, in the early postoperative period, became paraplegic, with concomitant sensory loss of the lower extremities distally. The neurological syndrome subsided fully 5 weeks later, after cyclosporine dosage modification. A woman, 47 years old, underwent heart transplantation due to end-stage dilated cardiomyopathy. Diazepam, lidocaine, midazolam, fentanyl citrate, and pancuronium bromide were used for induction and maintenance of anesthesia, and pethidine hydrochloride and acetaminophen were used |
| Databáze: | OpenAIRE |
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