Posterior encephalopathy subsequent to cyclosporin A presenting as irreversible abulia.
A case of cyclosporin A (Cys A)-induced posterior encephalopathy developed into persistent abulia despite rapid and marked improvement of abnormal T2- and FLAIR MRI hyperintense regions. Diffusion-weighted MRI signal intensity was also high at the onset. This change is atypical in Cys A-induced encephalopathy and was thought to predict poor recovery from the encephalopathy. Persistent abulia was probably due to marked hypoperfusion in the whole cortex including bilateral frontal lobes and basal ganglia as detected by SPECT. Apart from the breakdown of the blood-brain barrier, direct toxicity of Cys A to the brain may play a role in the pathogenesis of chronic, irreversible encephalopathy.
Nishie
Makoto
M
Department of Neurology, Aomori Prefectural Central Hospital, Aomori.
Kurahashi
Kozo
K
Ogawa
Masaya
M
Yoshida
Yasuji
Y
Midorikawa
Hiroshi
H
D000405:Akinetic Mutism / Q000139:chemically induced* / Q000175:diagnosis; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000139:chemically induced* / Q000175:diagnosis; D016572:Cyclosporine / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology*; D015899:Tomography, Emission-Computed, Single-Photon
D016572:Cyclosporine