Ciclosporin
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Cerebral vasospasm: case report A 48-year-old woman developed cerebral vasospasm during treatment with ciclosporin for aplastic anaemia. The woman was admitted with repetitive stroke-like episodes of sudden loss of strength in her left leg and numbness on the left side of her face. She had recently received antithymocyte globulin for 5 days in combination with ciclosporin and prednisolone to prevent acute serum sickness. Her current medications included oral ciclosporin 350mg twice daily [duration of treatment to reaction onset not stated], prednisone, ciprofloxacin and fluconazole. Her motor symptoms resolved within a few minutes to one hour after admission, although she continued to have a cold feeling in her left leg and left side of her face, Her haemoglobin level was 6.1 mmol/L and her thrombocyte count was 48 × 109/L. Her serum calcium and magnesium levels were 2.07 mmol/L and 0.56 mmol/L, respectively. The woman started receiving calcium and magnesium replenishment. Her serum ciclosporin concentration was 0.64 mg/L. A brain MRI showed small hyperintense punctuate foci in the watershed region of the right semioval centre up to the subcortical area between the anterior and middle cerebral arteries. Transcranial Doppler ultrasound showed segments of severely elevated flow velocities in several cerebral vessels, particularly both middle cerebral arteries. The findings were consistent with vasospasm. Her ciclosporin dose was decreased by 20%, and fluconazole and prednisone were discontinued. Immediately after, her stroke-like episodes disappeared. One week after the dose reduction, her serum ciclosporin concentration had normalised (0.29 mg/L). However, transcranial Doppler ultrasound showed no change in the blood flow velocities. Ciclosporin was then discontinued and, 6 weeks later, her Doppler ultrasound abnormalities had completely resolved. She remained asymptomatic. Author comment: "In this patient, we believe [ciclosporin]-induced vasospasm induced this clinical disease." Braakman HMH, et al. Vasospasm is a significant factor in cyclosporine-induced neurotoxicity: Case report. BMC Neurology 10: 11 May 2010. Available from: 803032680 URL: http://dx.doi.org/10.1186/1471-2377-10-30 - Netherlands
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Reactions 21 Aug 2010 No. 1315
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