Pseudotumor Cerebri Associated With Cyclosporine Use

Cruz, Oscar A.; Fogg, Steven G.; Roper-Hall, Gill

doi:10.1016/s0002-9394(14)72077-x

Cited by 52 publications

(31 citation statements)

References 3 publications

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“…5 For two decades, CsA has been reported as one cause of PC, especially following bone marrow transplantation. 3,6,7 There are few reports of PC in patients on CsA after renal transplantation, despite the large number of renal transplantations performed each year. 2,[8][9][10][11][12] Those patients are at higher risk to develop PC, due to corticotherapy, anemia, hypercoagulability state, and weight gain.…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebral associado ao uso de ciclosporina após transplante renal

Costa¹,

Almeida²,

Félix³

et al. 2010

J. Bras. Nefrol.

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Pseudotumor cerebri (PC) is a syndrome characterized by the presence of intracranial hypertension (ICH) and no alteration in the ventricular system. Renal transplanted patients seem more susceptible to develop it due to immunosuppressive therapy. Cyclosporin (CsA) is a rare cause of PC, scarcely reported in the literature, and should be considered in the differential diagnosis of ICH and papilledema in those patients. We report the case of a 10-year-old boy, with a renal allograft for three years, on chronic use of mycophenolate mophetil (MMF), CsA, and low doses of prednisone. The patient presented with headache, vomiting, diplopia, and photophobia. Funduscopy showed bilateral papilledema. Cerebrospinal fluid analysis and imaging tests were normal. After excluding secondary causes, PC was diagnosed based on the chronic use of CsA, which was then replaced by sirolimus. After that, the patient progressively improved, and the papilledema resolved in three months.

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Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebral associado ao uso de ciclosporina após transplante renal

Costa¹,

Almeida²,

Félix³

et al. 2010

J. Bras. Nefrol.

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“…But in our patient, the increase in intracranial pressure might explain the basis for the papilledema, macular rugae, and visual disturbances, but not the focal atrophy of the left optic disc. 6,7 CsA may induce microangiopathy of the optic nerve head. 8,9 We assume that the microangiopathy might be involved in the development of focal atrophy.…”

Section: Discussionmentioning

confidence: 99%

Successful Switch to Tacrolimus in a Patient with Pseudotumor Cerebri Following Cyclosporine a Treatment in Renal Transplantation

Lee

Jung

Rim

et al. 2009

Dialysis & Transplantation

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We report a case involving a 26‐year‐old Asian woman who developed pseudotumor cerebri (PTC) 2 years after renal transplantation. Cyclosporine A (CsA) was the only medication with a known neurotoxic side effect among her medications. CsA was discontinued and substituted with tacrolimus. After the CsA had been stopped, the elevated intracranial pressure gradually decreased and the bilateral papilledema finally normalized within 6 months. The case described herein is the first case of PTC that improved after renal transplantation by switching from CsA to tacrolimus.

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“…4,7 In a retrospective study Coskuncan et al 8 reported that 11 of 397 patients (2.8%) had bilateral optic disc edema after BMT, with eight cases attributed to the toxic effects of CsA and three to other causes.…”

Section: Discussionmentioning

confidence: 99%

“…These include cortical blindness, 1 microvascular retinopathy, 2 ocular flutter 3 and pseudotumor cerebri. 4 Because they potentially progress to cause life-threatening central nervous system (CNS) complications CsA must be discontinued in some cases.Papilledema is a sign of elevated intracranial pressure. Infection and infiltration by malignant cells in the CNS are the chief causes of this complication.…”

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confidence: 99%

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Unilateral papilledema after bone marrow transplantation

Saito

Kami

Taniguchi

et al. 1999

Bone Marrow Transplant

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Summary:We describe a patient who developed unilateral papilledema after allogeneic BMT. This is a rare manifestation of pseudotumor cerebri, which results from elevated intracranial pressure caused by cyclosporin A. The papilledema usually involves the fundi bilaterally, but unilateral involvement has been described. Congenital anomalies, compression and adhesion of the optic nerve sheath are its causes. In this patient, the right optic fundus was spared although leukemic infiltration was present on this side and high-dose irradiation (72 Gy) was given. Although papilledema is a sensitive marker of elevated intracranial pressure, this sign may be masked by constriction of the optic sheath in patients who suffer from leukemic infiltration of the central nervous system and receive high doses of cranial irradiation. Keywords: unilateral papilledema; pseudotumor cerebri; cyclosporine Ocular complications after BMT have been well described. Acute and chronic graft-versus-host disease (GVHD), conditioning therapy, prophylaxis and treatment of GVHD (corticosteroids and cyclosporin A) and a variety of infections may cause the ophthalmologic problems.The adverse ophthalmologic effects of cyclosporin A (CsA) are frequently reported. These include cortical blindness, 1 microvascular retinopathy, 2 ocular flutter 3 and pseudotumor cerebri. 4 Because they potentially progress to cause life-threatening central nervous system (CNS) complications CsA must be discontinued in some cases.Papilledema is a sign of elevated intracranial pressure. Infection and infiltration by malignant cells in the CNS are the chief causes of this complication. Sometimes, patients who have no definite signs of intracranial problems develop papilledema, which usually involves the fundi bilaterally. These are diagnosed as pseudotumor cerebri. However, unilateral involvement has also been reported, 5,6 but the exact pathomechanism is unknown. Here, we report a patient who Correspondence: Dr Y Fujino, Department of Ophthalmology, Tokyo University Branch Hospital, University of Tokyo, 3-28-6, Mejirodai, Bunkyoku, Tokyo 112-8688, Japan Received 24 August 1998; accepted 3 December 1998 developed unilateral papilledema after allogeneic BMT. This is the first report of this rare ocular complication after BMT. Case reportIn July 1996, a 26-year-old male with t(8;21) positive acute myeloid leukemia in second relapse was transferred to our hospital for allogeneic BMT. He had received 40 Gy of whole brain irradiation for the leukemic infiltration in the CNS and an additional 20 Gy for residual leukemia in the right mastoid sinus. We succeeded in controlling the CNS lesions with the radiotherapy and intrathecal MTX. No abnormalities were noted on the pre-transplant ophthalmologic examination.He underwent an allogeneic BMT in August 1996. Conditioning was with G-CSF, cytarabine, MCNU and fractionated TBI. GVHD prophylaxis was the combination of shortterm MTX and cyclosporine.The patient was seen at day 65 after BMT for routine ophthalmologic examination. At that t...

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Pseudotumor Cerebri Associated With Cyclosporine Use

Cited by 52 publications

References 3 publications

Pseudotumor cerebral associado ao uso de ciclosporina após transplante renal

Pseudotumor cerebral associado ao uso de ciclosporina após transplante renal

Successful Switch to Tacrolimus in a Patient with Pseudotumor Cerebri Following Cyclosporine a Treatment in Renal Transplantation

Unilateral papilledema after bone marrow transplantation

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