Perfusion-Dependent Focal Neurologic Deficits in a Critically Ill Heart Transplant Recipient: A Case of Tacrolimus-Associated Reversible Cerebral Vasospasm Syndrome?

Journal of cardiothoracic and vascular anesthesia 2023 Aug

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TACROLIMUS, a mainstay of immunosuppression after orthotopic heart transplantation (OHT), is associated with a broad range of side effects. Vasoconstriction caused by tacrolimus has been proposed as a mechanism underlying common side effects such as hypertension and renal injury. Neurologic side effects attributed to tacrolimus include headaches, posterior reversible encephalopathy syndrome (PRES), or reversible cerebral vasospasm syndrome (RCVS). Six case reports have been published describing RCVS in the setting of tacrolimus administration after OHT. The authors report a case of perfusion-dependent focal neurologic deficits attributed to tacrolimus-induced RCVS in an OHT recipient. Copyright © 2023 Elsevier Inc. All rights reserved.

Citation

Jamie Bloom, Micaela Langille Collins, Mia P Belovsky, Eric Feduska, Patrick Schofield, Ron Leong, John G Augoustides, Ilya Lembrikov, Alexander Kogan, Jonathan Frogel, Karuna Puttur Rajkumar, Megan H Hicks, Rohesh J Fernando. Perfusion-Dependent Focal Neurologic Deficits in a Critically Ill Heart Transplant Recipient: A Case of Tacrolimus-Associated Reversible Cerebral Vasospasm Syndrome? Journal of cardiothoracic and vascular anesthesia. 2023 Aug;37(8):1487-1494