title: Heterogeneity of radiological spectrum in tacrolimus-associated encephalopathy after lung transplantation.
abstract: BACKGROUND
  Tacrolimus-associated encephalopathy (TAC-E) is usually described under the term of posterior reversible encephalopathy syndrome (PRES). However, a large amount of data has suggested that TAC-E is not a homogenous entity: indeed, TAC-E which is often presented with atypical and potentially misleading imaging characteristics does not always correspond to PRES.
  
  
  OBJECTIVE
  We aimed to identify the spectrum of brain MR imaging of TAC-E and discuss the underlying pathophysiological features.
  
  
  METHODS
  From September 2008 to October 2010, the neurological statuses of 45 patients, who underwent lung transplantation with TAC as posttransplantation immunosuppressive therapy, were regularly assessed in a prospective study. MRI was repeatedly performed, until recovery, in patients who developed central neurological symptoms.
  
  
  RESULTS
  Symptoms suggestive of encephalopathy occurred in five out of 45 patients (11.1%). According to our MRI study, two patients presented with reversible bilateral and relatively symmetric subcortical white matter edema with proximal vasospasms on MRA; however, three other patients were characterized by coexistence of two different lesions including laminar cortical infarcts with hemorrhagic transformation not typically found in PRES and reversible deep white matter edema, associated with distal vasospasms on MRA.
  
  
  CONCLUSIONS
  It is considered that the mechanism of TAC-E would be more heterogenous than commonly perceived.
authors: Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing 400016, China.
authors: Qisi
authors: Q
authors: Wu
authors: Stroke Unit and Department of Vascular Neurology, University Hospital of Strasbourg, 67000 Strasbourg, France.
authors: Christian
authors: C
authors: Marescaux
authors: Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing 400016, China.
authors: Xinyue
authors: X
authors: Qin
authors: Department of Pulmonology, University Hospital of Strasbourg, 67000 Strasbourg, France.
authors: Romain
authors: R
authors: Kessler
authors: Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing 400016, China.
authors: Jun
authors: J
authors: Yang
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016040:Lung Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced / Q000473:pathology*; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus