Document Detail

PRES (posterior reversible encephalopathy syndrome), a rare complication of tacrolimus therapy.
MedLine Citation:
PMID:  19096887     Owner:  NLM     Status:  MEDLINE    
With increasing numbers of solid organ and hematopoietic stem cell transplantations being performed, there have been significant increases in the use of immunosuppressive agents such as cyclosporine and tacrolimus. Posterior reversible encephalopathy syndrome (PRES) is a serious complication of immunosuppressive therapy use following solid organ or stem cell transplants. Clinical findings including headache, mental status changes, focal neurological deficits, and/or visual disturbances. Associated with these are characteristic imaging features of subcortical white matter lesions on computed tomography (CT) or magnetic resonance imaging (MRI). The changes in the subcortical white matter are secondary to potentially reversible vasogenic edema, although conversion to irreversible cytotoxic edema has been described. These imaging findings predominate in the territory of the posterior cerebral artery. Many studies have shown that the neurotoxicity associated with tacrolimus may occur at therapeutic levels. In most cases of PRES, the symptom complex is reversible by reducing the dosage or withholding the drug for a few days. While PRES is an uncommon complication, it is associated with significant morbidity and mortality if it is not expeditiously recognized. MRI represents the most sensitive imaging technique for recognizing PRES. This report highlights the value of MRI in prompt recognition of this entity, which offers the best chance of avoiding long-term sequelae.
P Hodnett; J Coyle; K O'Regan; M M Maher; N Fanning
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-12-19
Journal Detail:
Title:  Emergency radiology     Volume:  16     ISSN:  1438-1435     ISO Abbreviation:  Emerg Radiol     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-22     Completed Date:  2010-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431227     Medline TA:  Emerg Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  493-6     Citation Subset:  IM    
Department of Radiology, Cork University Hospital and University College Cork, Cork, Ireland.
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MeSH Terms
Diffusion Magnetic Resonance Imaging
Immunosuppressive Agents / adverse effects*
Neurotoxicity Syndromes / diagnosis*,  etiology*
Tacrolimus / adverse effects*
Tomography, X-Ray Computed
Reg. No./Substance:
0/Immunosuppressive Agents; 109581-93-3/Tacrolimus

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