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Reversible Cerebral Perfusion Abnormalities Associated with Cyclosporine Therapy in Orthotopic Liver Transplantation

Division of Nuclear Medicine, Department of Radiology, and Departments of Neurology and Diagnostic Radiology, Mount Sinai School of Medicine, New York, New York

Correspondence: For correspondence or reprints contact: Mordechai Lorberboym, MD, Division of Nuclear Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

ABSTRACT

A 60-yr-old woman experienced several episodes of generalized seizures following 2 wk of immunosuppressive therapy with cyclosporine for orthotopic liver transplantation. CT showed low density in the white matter of the parieto-occipital lobes. A ^99mTc-HMPAO brain SPECT showed diminished perfusion in the parieto-occipital cortex bilaterally. Although the cyclosporine was discontinued, the patient's neurologic status initially worsened and then improved over the next several days. Repeat perfusion brain SPECT showed resolution of most of the perfusion abnormalities, while repeat CT showed persistent white matter changes in the parieto-occipital lobes. We report the presence of reversible cortical perfusion abnormalities in conjunction with cyclosporine therapy. The findings suggest that perfusion brain SPECT may be a sensitive monitor of cyclosporine-induced neurotoxicity.

Key Words: cyclosporine • liver transplantation • seizures • brain SPECT

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