Cyclosporine A-associated fatal central nervous system angiopathy in a bone marrow transplant recipient: an autopsy case

We report here the case of a 32-year-old woman who suffered from a unique a ngiopathy in the central nervous system (CNS). She died of multiple infarct s in the brain stem and cerebellum during treatment with cyclosporine A aft er bone marrow transplantation for refractory anemia with excess of blasts. The autopsy findings showed segmental narrowing of the basilar artery, in which circumferential dissection of the internal elastic lamina had occurre d. The distal portion of the basilar artery was obstructed by upward disloc ation of the dissected intima. Similar angiopathy was also observed at mult iple sites along the basilar artery branches. These findings suggest endoth elial damage, including vasoconstriction and dissection of the CNS arteries .