Jansen O, Krieger D, Krieger S, Sartor K
Department of Neuroradiology, University of Heidelberg School of Medicine, Germany.
AJNR Am J Neuroradiol. 1996 Feb;17(2):337-44.
To describe cortical hyperintensities in proton density-weighted images in six patients with presumed cyclosporine-induced neurotoxicity.
In six patients with clinical evidence of cyclosporine-related encephalopathy, MR imaging was performed after the onset of symptoms and signs (mean, 24 days after liver transplantation). Five of these patients had serial MR imaging for a period that varied from 2 to 20 months. Along with the imaging studies, the patients' clinical status was evaluated and various laboratory parameters, including blood pressure and levels of cyclosporine, cholesterol, and magnesium, were monitored.
In all six patients, initial MR studies showed hyperintensity of several cerebral gyri that was unequivocal only on proton density-weighted images. Although in five patients these signal abnormalities were limited to the cortex, one patient had increased signal in the subjacent white matter as well. In one patient, the images were also remarkable for areas of cortical hyperintensities on T1-weighted images. In another patient, cortical enhancement occurred after administration of gadopentetate dimeglumine, with a normal cortical signal on the precontrast images. The abnormal cortical signal began to fade after cyclosporine reduction, but in two patients it remained visible for at least 20 months. The neurologic symptomatology associated with cyclosporine-induced neurotoxicity included seizures (three patients), speech disorder (three patients), and disturbance of consciousness (three patients).
Cyclosporine-induced neurotoxicity occurring in patients after liver transplantation appears to affect the cerebral cortex preferentially. Because its MR equivalent resembles changes resulting from hypoxic injury or cortically centered vasculitis, we suspect the underlying mechanism may be a vascular injury that results in cortical hypoperfusion.
描述6例疑似环孢素诱导神经毒性患者质子密度加权图像中的皮质高信号。
对6例有环孢素相关脑病临床证据的患者，在症状和体征出现后（平均肝移植后24天）进行磁共振成像（MR成像）检查。其中5例患者进行了为期2至20个月的系列MR成像检查。除影像学检查外，还评估了患者的临床状态，并监测了包括血压以及环孢素、胆固醇和镁水平在内的各种实验室参数。
所有6例患者的初次MR研究均显示数个脑回呈高信号，仅在质子密度加权图像上明确显示。虽然5例患者这些信号异常仅限于皮质，但1例患者其下方白质也出现信号增强。1例患者的T1加权图像上皮质高信号区域也很明显。另1例患者静脉注射钆喷酸葡胺后皮质出现强化，注射前图像上皮质信号正常。降低环孢素剂量后，异常皮质信号开始消退，但2例患者至少20个月内仍可见。与环孢素诱导神经毒性相关的神经系统症状包括癫痫发作（3例患者）、言语障碍（3例患者）和意识障碍（3例患者）。
肝移植患者发生的环孢素诱导神经毒性似乎优先影响大脑皮质。由于其MR表现类似于缺氧性损伤或皮质中心性血管炎导致的改变，我们怀疑潜在机制可能是导致皮质灌注不足的血管损伤。
