Prolonged reversible vasospasm in cyclosporin A-induced encephalopathy

Abstract

The mechanisms responsible for cyclosporin-induced encephalopathy remain controversial. Herein we present a case of cyclosporin-induced encephalopathy with unusually prolonged vasospasm, which might have contributed to the slow recovery of the patient.

Fig 1.

A–C, MR images and MRAs obtained 6 days after symptom onset. D–F, MR images and MRAs obtained 27 days after symptom onset. A, MRA shows evidence of a marked narrowing of the M1 segment of the bilateral MCAs (arrows) and the P2 segment of the right PCA (arrowhead). B, T2-weighted MR image (TR/TE/NEX, 3200/100/2) shows a hyperintense lesion in the right parieto-occipital region. The lesion seemed to be mainly in the subcortical white matter. C, Diffusion-weighted MR image (b=1000) shows evidence of a hyperintense lesion in the right parieto-occipital region, as compared with the T2-weighted image. Obvious involvement to the cortical region was also identified. Cytotoxic edema was indicated by measuring the ADCs. D, MRA shows recovery of the lumen of the bilateral MCAs and right PCAs. This finding indicates that the vascular lesion seen in the previous MRA was caused by the vasospasm. E, T1-weighted MR image (400/17/2) obtained after an intravenous injection of gadolinium-based contrast agent reveals curvilinear enhancement along the course of the gyri (arrows). This finding indicates cortical involvement. F, The hyperintense lesion seen on the previous diffusion-weighted image became smaller and was located in the white matter. This finding indicates recovery of the diffusion activity in most of the hyperintense part seen on the previous diffusion-weighted image.