Posterior Reversible Encephalopathy Syndrome: paediatric heart transplant with cyclosporine neurotoxicity

Abstract

Posterior reversible encephalopathy syndrome (PRES) is associated with a specific disorder of cerebrovascular autoregulation. Clinical features of PRES consisted of headache, decreased consciousness, altered mental functioning, seizures, visual loss or cortical blindness. Characteristic findings on neuroimaging included high signal intensity on T2-weighted as well as diffusion-weighted imaging MRI in the posterior cerebral hemispheres, indicative of vasogenic subcortical oedema without infarction. Cyclosporine neurotoxicity had been described following bone marrow and organ transplantation; however, there are few reports of PRES in children especially post-paediatric heart transplantation. We report a case of cyclosporine-related PRES in a paediatric heart transplant recipient. She made a good recovery with no residual neurological deficits after withdrawal of cyclosporine, control of possible risk factors as well as symptomatic control of seizure.