Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome with Delayed Multi-Segmental Vasoconstriction

Satoshi Kodama; Tatsuo Mano; Akihiro Masuzawa; Yasutaka Hirata; Yuki Nagasako; Kagari Koshi Mano; Masashi Hamada; Yasuo Terao; Toshihiro Hayashi; Minoru Ono; Shoji Tsuji

doi:10.1016/j.jstrokecerebrovasdis.2017.03.006

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Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome with Delayed Multi-Segmental Vasoconstriction

Journal article

Peer reviewed

Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome with Delayed Multi-Segmental Vasoconstriction

Satoshi Kodama, Tatsuo Mano, Akihiro Masuzawa, Yasutaka Hirata, Yuki Nagasako, Kagari Koshi Mano, Masashi Hamada, Yasuo Terao, Toshihiro Hayashi, Minoru Ono, …

Journal of stroke and cerebrovascular diseases, Vol.26(5), pp.e75-e77

05/01/2017

DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.006

PMID: 28342655

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Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular syndrome characterized by multi-segmental constrictions of the cerebral arteries that resolves spontaneously within 3 months. Although RCVS is considered to be due to transient dysregulation of vascular tone, the exact pathomechanism remains unclear. We describe the case of a 15-year-old girl with RCVS induced by tacrolimus, who developed generalized seizure during the postoperative course of orthotropic heart transplantation. Magnetic resonance imaging at symptom onset showed a few vasoconstrictions accompanying brain edema and convexity subarachnoid hemorrhage. Although her neurological conditions rapidly improved after discontinuing tacrolimus, a repeat magnetic resonance angiogram demonstrated delayed progression of the multi-segmental vasoconstrictions followed by subsequent resolution. Our case demonstrates that cautious observation of the cerebral arteries using magnetic resonance angiography and careful management of vasoconstrictions with vasodilators are necessary for delayed vasoconstrictions even when the clinical symptoms improve.

angiography

calcineurin inhibitor

magnetic resonance imaging

stroke

subarachnoid hemorrhage

Vasoconstriction

Details

Title: Subtitle: Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome with Delayed Multi-Segmental Vasoconstriction
Creators: Satoshi Kodama - The University of Tokyo
Tatsuo Mano - The University of Tokyo
Akihiro Masuzawa - The University of Tokyo
Yasutaka Hirata - The University of Tokyo
Yuki Nagasako - The University of Tokyo
Kagari Koshi Mano - Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Masashi Hamada - The University of Tokyo
Yasuo Terao - The University of Tokyo
Toshihiro Hayashi - The University of Tokyo
Minoru Ono - The University of Tokyo
Shoji Tsuji - The University of Tokyo
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.26(5), pp.e75-e77
DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.006
PMID: 28342655
ISSN: 1052-3057
eISSN: 1532-8511
Publisher: Elsevier Inc
Language: English
Date published: 05/01/2017
Academic Unit: Neurology
Record Identifier: 9985177941002771

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