Neurological management

Recovery of consciousness from grade IV encephalopathy after a successful transplant may take more than a week. Daily electroencephalographic recordings are helpful to demonstrate progress and exclude epileptiform activity. New or worsening neurological dysfunction may indicate graft failure, seizures, severe sodium shifts with central pontine myelinolysis, cerebral edema, cerebral hemorrhage, or cyclosporine toxicity, particularly in the presence of severe hypomagnesemia. Late-onset impairment of conscious level or seizures suggests cyclosporine toxicity or cerebral infection with Aspergillus or cytomegalovirus.

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