Abstract
The organ transplantation is a therapeutic alternative increasingly common in our country, thus, the complications and effects of immunosuppressive medications that affect the Central Nervous System (CNS).
The Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by neurological manifestations associated with changes in neuroimaging, together with precipitating factors, among which the use of immunosuppressive, chemotherapy and certain medical conditions such as hypertension and kidney diseases stand out. The clinical radiological features of this disorder are usually reversible with discontinuation of the precipitating factors; however a delayed diagnosis may lead to a fatal outcome. A case of PRES on a young patient who underwent an emergency heart transplant occurred in our institution. During his post operative care received tacrolimus as part of the transplant management.
In the fourth week of post operative treatment and the fifth day of the use of tacrolimus, the patient presented headache associated with high pressure values, impaired consciousness and episodes of generalized tonic-clonic seizure, the neurological symptoms reversed within 48 hours after the withdrawal of tacrolimus, as well as changes in neuroimaging who decided one month after the initial manifestations.
References
Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500.
Striano P, Striano S, Servillo G, et al. Posterior reversible encephalopathy syndrome and spinal epidural haematoma in a hypertensive patient. Eur J Anesthesiol 2007;24:10757-1069.
Garg RK. Posterior leukoencephalopathy syndrome. Postgrad Med J 2001;77:24-28.
Onrubia X, Lluch-Oltra A, Armero R, Higueras R, Sifre C, Barberá M. Posterior reversible encephalopathy syndrome after a cesarean delivery. Anesth Analg 2007;104:746-747.
Thackeray E, Tielborg M. Posterior reversible encephalopathy syndrome in a patient with severe preeclampsia. Anesth Analg 2007;105:184-186.
Long T, Hein B, Brown M, Rydberg Ch, Wass T. Posterior reversible encephalopathy syndrome during pregnancy: seizures in a previously healthy parturient. J Clin Anesth 2007;19:145-148.
Fitzgerald J, King M. Posterior reversible encephalopathy syndrome: A case study. J Neurosci Nurs 2006;38:338-341.
Bodkin C, Eidelman B. Sirolimus-Induced posterior reversible encephalopathy. Neurology 2007; 68: 2039-2040.
Hernandez M, Nunez A, Mesa T, Escobar R, Barriga F, Huete I. Reversible posterior leukoencephalopathy syndrome in patients with immunosuppressive treatment: Report of four cases. Rev Med Chile 2008;136:93-98.
Kwon E, Kim S, Kim K, Seo H, Kim D. A case of gemcitabine and cisplatin associated posterior reversible encephalopathy syndrome. Cancer Res Treat 2009;41:53-55.
Bûrki F, Badie K, Bartoli P, Bernard P, Montastruc JL, Bagheri H. Reversible posterior leukoencephalopathy syndrome associated with bevacizumab/doxorubicin regimen. Br J Clin Pharmacol 2008;65:793-794.
Won SC, Kwon SY, Han JW, Choi SY, Lyu CJ. Posterior reversible encephalopathy syndrome in childhood with hematologic oncologic diseases. J Pediatr Hematol Oncol 2009;31:505-508.
Estadística donación y trasplante Latinoamérica año 2006. Instituto nacional de salud.
Coordinación nacional red donación y trasplantes. Instituto Nacional de salud. Actividad de donación y trasplantes. América Latina 2007.
Coordinación nacional red de donación y trasplante. Informe de trasplantes de órganos y tejidos 2008. Informe Enero a Diciembre de 2008, trasplante de órganos. Instituto nacional de salud. Abril de 2009.
Informe red donación y trasplantes 2009. Instituto Nacional de Salud. Colombia. Marzo de 2010. Subdirección red nacional de laboratorios, coordinación nacional red donación y trasplantes.
Muñoz P, Valerio M, Palomo J, et al. Infectious and non-Infectious neurologic complications in heart transplant recipients. Medicine 2010;89:166-175.
Ponticelli C, Campise MR. Neurological complications in kidney transplant recipients. J Nephrol 2005;18:521-528.
Feltracco P, Barbieri S, Furnari M, et al. Central nervous system infectious complications early after liver transplantation. Transplant Proc 2010;42:1216-1222.
Sakai M, Ohashi K, Yamashita T, et al. Immune-mediated myelopathy following allogenic stem cell transplantation. International Journal of Hematology 2006; 84: 272-275.
Liang B. Neurologic complications of orthotopic liver transplantation. Hospital physician 2000;0:43-46.
Belvís R, Fabregás JM, Cocho D, et al. Cerebrovascular disease as a complication after cardiac transplantation. Cerebrovasc Dis 2005;19:267-271.
Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. Am J Neuroradiol 2002;23:1038-1048.
Kwon S, Lee S. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Pediatr Neurol 2001;24:361-364.
Alehan F, Erol I, Agildere AM, et al. Posterior leukoencephalopathy syndrome in children and adolescents. J Child Neurol 2007;22:406-413.
Stott VL, Hurrell MA, Anderson TJ. Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed. Intern Med J 2005;35:83-90.
Nakagawa K, Serrador J, LaRose S, Moslehi F, Lipsitz L, Sorond F. Autoregulation in the posterior circulation is altered by the metabolic state of the visual cortex. Stroke 2009;40:2062-2067.
Savvidou MD, Hingonari AD, Tsikas D, Frolich JC, Vallance P, Nocolaides KH. Endothelial dysfunction and raises plasma concentrations of asymmetric dimethylarginine in pregnant women who subsequently develop pre-eclampsia. Lancet 2003;361:1511-1517.
Beasuang-Linder M, Bill A. Cerebral circulation in acute arterial hypertension - protective effects of sympathetic nervous activity. Acta Physiol Scand 1981;111: 193-199.
Ito Y, Arahata Y, Goto Y, et al. Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome. Am J Neuroradiol 1998;19:415-417.
Pula JH, Eggenberger E. Posterior reversible encephalopathy syndrome. Curr Opin Ophthalmol 2008;19:479-484.
Kozak OS, Wijdicks EF, Manno EM, Miley JT, Rabinstein AA. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology 2007;69:894-897.
Moawad FJ, Hartzell JD, Biega TJ, Lettieri CJ. Transient Blindness due to posterior reversible encephalopathy following ephedra overdose. South Med J 2006;99:511-514.
Lamy C, Oppenheim C, Meder JF. Neuroimaging in posterior reversible encephalopathy syndrome. J Neuroimaging 2004;14:89-96.
Gijtenbeek JM, Van den Bent MJ, Vecht CJ. Cyclosporine neurotoxicity: a review. J Neurol 1999;246:339-346.
Oda N, Kato T, Hanatani A, et al. Reversible posterior leukoencephalopathy syndrome (RLPS) in a heart transplant recipient treated by substitution of cyclosporine A with tacrolimus. Intern Med 2010;49:1013-1016.
Antunes NL, Small TN, George D, Boulad F, Lis E. Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol 1999;20:241-243.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.