Neurophysiologic evaluation of cyclosporine toxicity associated with bone marrow transplantation.

INTRODUCTION

Cortical blindness, a rare form of cyclosporine (CSA) neurotoxicity, has previously been described in only nine bone marrow transplant (BMT) recipients.

METHODS

Our institution averages 35 allogeneic BMT's per year. In the past year we have seen two women with reversible cortical blindness secondary to CSA toxicity.

RESULTS

Age (years) (Case 1; Case 2): 32; 22. Day post-BMT: 41; 50. Peak CSA level (ng/ml): 1159; 632. Both had a history of renal toxicity requiring adjustment of CSA dosage. MRI - both with diffuse while matter changes. EEG - both with moderate to severe generalized slowing. Visual evoked potentials were markedly prolonged in both. Auditory evoked potentials: minimally abnormal; normal. Somatosensory evoked potentials - both normal. Prompt improvement occurred with discontinuation of CSA. Followup neurophysiologic evaluations were normal, however structural changes remained on MRI.

CONCLUSION

As neurophysiologic studies closely follow the clinical status they should be included in the evaluation and followup of CSA neurotoxicity.