Neurologic Considerations in Critically Ill Hematopoietic Stem Cell Transplantation Patients

While advances in hematopoietic stem cell transplantation (HSCT) have facilitated more widespread use of this technique in a variety of disorders and for a broader range of patients, this has exposed more vulnerable patients to the combined and cumulative risks of immunosuppression, drug toxicity, and cytopenia. This can result in infections, bleeding, and other serious complications that frequently affect the central and peripheral nervous system (CNS/PNS) and are a significant source of early and delayed morbidity and transplant-related mortality. The most common presentations of neurological complications include encephalopathy, seizures, and focal neurological deficits. In this chapter, we will present an approach to evaluating patients with neurological complications after HSCT and discuss major classes of complications, including drug neurotoxicity, CNS infections, and immune-mediated neurological disorders. Awareness, recognition, and appropriate evaluation of these complications in the critical care setting may improve clinical outcomes after HSCT.