Wijdicks E F, Wiesner R H, Krom R A
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Neurology. 1995 Nov;45(11):1962-4. doi: 10.1212/wnl.45.11.1962.
We studied the clinical features, blood levels of cyclosporine, and neuroimaging findings in 46 patients with cyclosporine neurotoxicity after liver transplantation. The clinical presentation of cyclosporine neurotoxicity was characterized by tremulousness and restlessness in all patients and was associated with acute confusional state and psychosis in 20 patients, seizures in eight, speech apraxia or action myoclonus speech in three, and cortical blindness in two. In 35 patients, cyclosporine neurotoxicity occurred during IV treatment. Neuroimaging studies showed only minor white matter abnormalities in two patients despite dramatic clinical presentations, including speech difficulties, seizures, and cortical blindness. In only 19 of 31 patients (61%) did trough levels of cyclosporine suggest neurotoxicity. Neurologic findings were reversible in all patients after cyclosporine was withheld and then given in lower dosage. In three patients, substituting FK 506 did not result in neurotoxicity.
我们研究了46例肝移植后发生环孢素神经毒性患者的临床特征、环孢素血药浓度及神经影像学表现。所有患者环孢素神经毒性的临床表现均以震颤和烦躁不安为特征，20例患者伴有急性意识模糊状态和精神病，8例有癫痫发作，3例有言语失用或动作性肌阵挛性言语，2例有皮质盲。35例患者的环孢素神经毒性发生在静脉治疗期间。神经影像学研究显示，尽管有包括言语困难、癫痫发作和皮质盲在内的显著临床表现，但仅有2例患者有轻微的白质异常。在31例患者中，只有19例（61%）的环孢素谷浓度提示存在神经毒性。在停用环孢素然后给予较低剂量后，所有患者的神经学表现均可逆。3例患者改用FK 506未导致神经毒性。
