Wijdicks E F
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Liver Transpl. 2001 Nov;7(11):937-42. doi: 10.1053/jlts.2001.27475.
The clinical profile of neurotoxicity caused by immunosuppression has changed. When toxic levels are reached, both cyclosporine and tacrolimus may produce a clinical spectrum that varies from tremor and acute confusional state to status epilepticus and major speech or language abnormalities. Coma has become an unusual manifestation. Magnetic resonance imaging has been better defined, and abnormalities may be more widespread than those in the posterior lobes. These white matter lesions are caused by vasogenic edema, but may lead to apoptosis and cytotoxic edema if exposure is prolonged. Recent evidence suggests inhibition of a drug-efflux pump and dysfunction of the blood-brain barrier by enhanced nitric oxide production.
免疫抑制所致神经毒性的临床特征已发生变化。当达到中毒水平时，环孢素和他克莫司均可产生一系列临床症状，从震颤、急性意识模糊状态到癫痫持续状态以及严重的言语或语言异常不等。昏迷已成为一种不常见的表现。磁共振成像已得到更好的界定，其异常可能比后叶更广泛。这些白质病变由血管源性水肿引起，但如果暴露时间延长，可能会导致细胞凋亡和细胞毒性水肿。最近的证据表明，药物外排泵受抑制以及一氧化氮生成增加导致血脑屏障功能障碍。
