Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome with Delayed Multi-Segmental Vasoconstriction.
Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular syndrome characterized by multi-segmental constrictions of the cerebral arteries that resolves spontaneously within 3 months. Although RCVS is considered to be due to transient dysregulation of vascular tone, the exact pathomechanism remains unclear. We describe the case of a 15-year-old girl with RCVS induced by tacrolimus, who developed generalized seizure during the postoperative course of orthotropic heart transplantation. Magnetic resonance imaging at symptom onset showed a few vasoconstrictions accompanying brain edema and convexity subarachnoid hemorrhage. Although her neurological conditions rapidly improved after discontinuing tacrolimus, a repeat magnetic resonance angiogram demonstrated delayed progression of the multi-segmental vasoconstrictions followed by subsequent resolution. Our case demonstrates that cautious observation of the cerebral arteries using magnetic resonance angiography and careful management of vasoconstrictions with vasodilators are necessary for delayed vasoconstrictions even when the clinical symptoms improve.
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Satoshi
S
Kodama
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: tatsuomano@gmail.com.
Tatsuo
T
Mano
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Akihiro
A
Masuzawa
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yasutaka
Y
Hirata
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yuki
Y
Nagasako
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kagari
K
Koshi Mano
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masashi
M
Hamada
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yasuo
Y
Terao
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Toshihiro
T
Hayashi
Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Minoru
M
Ono
Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Shoji
S
Tsuji
D000293:Adolescent; D001929:Brain Edema / Q000139:chemically induced; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000187:drug effects* / Q000503:physiopathology; D018450:Disease Progression; D004569:Electroencephalography; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D018810:Magnetic Resonance Angiography; D064847:Multimodal Imaging; D012640:Seizures / Q000139:chemically induced; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced; D013577:Syndrome; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014661:Vasoconstriction / Q000187:drug effects*; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology
D007166:Immunosuppressive Agents; D014665:Vasodilator Agents; D016559:Tacrolimus
Vasoconstriction; angiography; calcineurin inhibitor; magnetic resonance imaging; stroke; subarachnoid hemorrhage