Neurophysiologic evaluation of cyclosporine toxicity associated with bone marrow transplantation.
BACKGROUND
Cortical blindness, a rare form of cyclosporine (CSA) neurotoxicity, has previously been described in only nine bone marrow transplant (BMT) recipients.


METHODS
Our institutions averages 35 allogeneic BMT's per year. In the past year we have seen two women with reversible cortical blindness secondary to CSA toxicity.


RESULTS
Age (years) (Case 1; Case 2): 32; 22. Day post-BMT: 41: 50. Peak CSA level (ng/ml): 1159; 632. Both had a history of renal toxicity requiring adjustment of CSA dosage. MRI - both with diffuse white matter changes. EEG-both with moderate to severe generalized slowing. Visual evoked potentials were markedly prolonged in both. Auditory evoked potentials: minimally abnormal; normal. Somatosensory evoked potential - both normal. Prompt improvement occurred with discontinuation of CSA. Followup neurophysiologic evaluations were normal, however structural changes remain on MRI.


CONCLUSIONS
As neurophysiologic studies closely follow the clinical status they should be included in the evaluation and followup of CSA neurotoxicity.
Edwards
L L
LL
University of Nebraska Medical Center, Omaha, USA.
Wszolek
Z K
ZK
Normand
M M
MM
D000328:Adult; D001766:Blindness / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D016026:Bone Marrow Transplantation; D001927:Brain Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D002540:Cerebral Cortex / Q000503:physiopathology; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D004569:Electroencephalography; D016057:Evoked Potentials, Auditory, Brain Stem; D005074:Evoked Potentials, Visual; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
D016572:Cyclosporine