Magnetic Resonance Imaging for the Diagnosis of Acute Leukoencephalopathy in Children Treated with Tacrolimus

Abstract

The leukoencephalopathy induced by tacrolimus is increasingly recognised as an important cause of neurological complications after transplantation. Magnetic resonance imaging (MRI) is of major help in the differential diagnosis of infection or vascular injury. We describe two children with coma and seizures after transplantation, in whom the results of MRI with FLAIR (fluid-attenuated inversion-recovery) and DWI (diffusion-weighted images) were the main positive elements for the diagnosis of drug-induced toxicity. The results of DWI favoured the role of oedema and/or demyelination in the pathophysiology of this disorder. Unlike other reported patients, in whom all symptoms resolved, lesions persisted, albeit improved, on the control MRI, and both children demonstrated learning disabilities after several years of follow-up.

Key words

Leukoencephalopathy - tacrolimus - magnetic resonance imaging

References

• 1 Bonham C A, Dominguez E A, Fukui M B. et al . Central nervous system lesions in liver transplant recipients: prospective assessment of indications for biopsy and implications for management.  Transplantation. 1998;  66 1596-1604
• 2 De Groen P C, Aksamit A J, Rakela J, Forbes G S, Krom R AF. Central nervous system toxicity after liver transplantation. The role of ciclosporine and cholesterol.  N Engl J Med. 1987;  317 861-866
• 3 Filley C M, Kleinschmidt-DeMasters B K. Toxic leukoencephalopathy.  N Engl J Med. 2001;  345 425-432
• 4 Frühauf N R, Koeppen S, Saner F H, Egelhof T, Stavrou G, Nadalin S, Broelsch C E. Late onset of tacrolimus-related posterior leukoencephalopathy after living donor liver transplantation.  Liver Transpl. 2003;  9 983-985
• 5 Kochi S, Takanaga H, Matsuo H, Naito M, Tsuruo T, Sawada Y. Effect of cyclosporin A or tacrolimus on the function of blood-brain barrier cells.  Eur J Pharmacol. 1999;  372 287-295
• 6 Menegaux F, Keeffe E B, Andrews B T. et al . Neurological complications of liver transplantation in adult versus pediatric patients.  Transplantation. 1994;  58 447-450
• 7 Parvex P, Pinsk M, Bell L E, O'Gorman A MG, Patenaude Y G, Gupta I R. Reversible encephalopathy associated with tacrolimus in pediatric renal transplants.  Pediatr Nephrol. 2001;  16 537-542
• 8 Romero J M, Schaefer P W, Grant P E, Becerra L, Gonzalez R G. Diffusion MR imaging of acute ischemic stroke.  Neuroimaging Clin N Am. 2002;  12 35-53
• 9 Singh N, Bonham A, Fukui M. Immunosuppressive-associated leukoencephalopathy in organ transplant recipients.  Transplantation. 2000;  69 467-472
• 10 Small S, Fukui M, Bramblett G T, Eidelman B H. Immunosuppression-induced leukoencephalopathy from tacrolimus (FK506).  Ann Neurol. 1996;  40 575-580
• 11 Torocsik H V, Curless R G, Post J, Tzakis A G, Pearse L. FK506-induced leukoencephalopathy in children with organ transplants.  Neurology. 1999;  52 1497-1500
• 12 Wijdicks E F, Wiesner R H, Dahlke L J, Krom R A. FK506-induced neurotoxicity in liver transplantation.  Ann Neurol. 1994;  35 498-501