WATERSHED IMAGING FEATURES AND CLINICAL VASCULAR INJURY IN CYCLOSPORINE-A NEUROTOXICITY

Purpose: The purpose of our study was to assess whether the imaging an d clinical features of cyclosporin A (CsA) neurotoxicity support a vas cular ''watershed'' cause for the brain lesions observed. Method: Four teen patients receiving CsA after allogeneic bone marrow transplantati on or with marrow aplastic disorders developed neurotoxicity and MR or CT imaging abnormalities. The locations of brain lesions were analyze d, and clinical features, in particular bone marrow transplant thrombo tic microangiopathy (BMT-TM), were assessed. Results: Sixty-six lesion s had consistent locations in watershed zones between major cerebral v essels or their main branches, including the parietal area (19), occip ital poles (18), frontoparietal junction (15), inferior temporooccipit al junction (10), and cerebellum (3). BMT-TM was identified in 10 of 1 0 marrow transplant patients studied. Conclusion: Vascular injury, sug gested from watershed location and BMT-TM, likely establishes the loca tion of the brain lesions in CsA neurotoxicity. Secondary toxicity in these vulnerable regions may cause the white matter lesions.