Gijtenbeek J M, van den Bent M J, Vecht C J
Department of Neuro-oncology, Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
J Neurol. 1999 May;246(5):339-46. doi: 10.1007/s004150050360.
Cyclosporin A (CsA) induces neurological side effects in up to 40% of patients. A reversible posterior leukoencephalopathy syndrome is the most serious complication. Symptoms include headache, altered mental functioning, seizures, cortical blindness, and other visual disturbances, with hypertension. Neuroimaging studies show white matter changes in the posterior regions of the brain. Other neurological side effects of CsA include tremor, diffuse encephalopathy, cerebellar syndrome, extrapyramidal syndrome, pyramidal weakness, and peripheral neuropathy. Hypertension, hypomagnesemia, hypocholesteremia, and the vasoactive agent endothelin may all play a role in the pathogenesis of CsA neurotoxicty. Neurotoxicity is more frequent with high CsA blood levels, but levels may be within the therapeutic range. Dose reduction or withdrawal of CsA usually results in resolution of clinical symptoms and of neuroimaging abnormalities.
环孢素A（CsA）在高达40%的患者中会引发神经副作用。可逆性后部白质脑病综合征是最严重的并发症。症状包括头痛、精神功能改变、癫痫发作、皮质盲和其他视觉障碍，并伴有高血压。神经影像学研究显示大脑后部区域有白质变化。CsA的其他神经副作用包括震颤、弥漫性脑病、小脑综合征、锥体外系综合征、锥体肌无力和周围神经病变。高血压、低镁血症、低胆固醇血症和血管活性物质内皮素可能都在CsA神经毒性的发病机制中起作用。高CsA血药浓度时神经毒性更常见，但血药浓度可能在治疗范围内。减少CsA剂量或停药通常会使临床症状和神经影像学异常得到缓解。
