Heterogeneity of Radiological Spectrum in Tacrolimus-Associated Encephalopathy after Lung TransplantationReport as inadecuate




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Behavioural NeurologyVolume 2014 2014, Article ID 931808, 9 pages

Clinical Study

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing 400016, China

Stroke Unit and Department of Vascular Neurology, University Hospital of Strasbourg, 67000 Strasbourg, France

Department of Pulmonology, University Hospital of Strasbourg, 67000 Strasbourg, France

Received 1 February 2014; Accepted 17 April 2014; Published 27 May 2014

Academic Editor: Rik Vandenberghe

Copyright © 2014 Qisi Wu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Tacrolimus-associated encephalopathy TAC-E is usually described under the term of posterior reversible encephalopathy syndrome PRES. However, a large amount of data has suggested that TAC-E is not a homogenous entity: indeed, TAC-E which is often presented with atypical and potentially misleading imaging characteristics does not always correspond to PRES. Objective. We aimed to identify the spectrum of brain MR imaging of TAC-E and discuss the underlying pathophysiological features. Methods. From September 2008 to October 2010, the neurological statuses of 45 patients, who underwent lung transplantation with TAC as posttransplantation immunosuppressive therapy, were regularly assessed in a prospective study. MRI was repeatedly performed, until recovery, in patients who developed central neurological symptoms. Results. Symptoms suggestive of encephalopathy occurred in five out of 45 patients 11.1%. According to our MRI study, two patients presented with reversible bilateral and relatively symmetric subcortical white matter edema with proximal vasospasms on MRA; however, three other patients were characterized by coexistence of two different lesions including laminar cortical infarcts with hemorrhagic transformation not typically found in PRES and reversible deep white matter edema, associated with distal vasospasms on MRA. Conclusions. It is considered that the mechanism of TAC-E would be more heterogenous than commonly perceived.





Author: Qisi Wu, Christian Marescaux, Xinyue Qin, Romain Kessler, and Jun Yang

Source: https://www.hindawi.com/



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