Cyclosporine-related brainstem atypical posterior reversible leukoencephalopathy syndrome following hematopoietic stem cell transplant

Posterior reversible leukoencephalopathy syndrome (PRES) is a rare and severe complication of calcineurin inhibitor neurotoxicity, especially following high risk procedures, such as hematopoietic stem cell transplantation (HSCT).We report an isolated brainstem localization of PRES in a 23-year-old patient who, two days following cyclosporine (CsA) administration, manifested gradual symptoms that included hypertension, vomiting, vertigo, tremor, nystagmus, and visual disturbance.Radiologic magnetic resonance imaging (MRI) showed two bilateral punctiform, increased signals on T2 with fluid attenuation inversion recovery (FLAIR) in the pons.The patient's symptoms, as well as MRI signs, were resolved when the cyclosporine treatment was discontinued.Posterior reversible leukoencephalopathy syndrome (PRES) is a rare clinical and radiological inflammatory complication, involving the central nervous system and the impairment of the blood brain barrier.Clinical symptoms may include headache, vomiting, mental confusion, seizures, coma, cortical blindness and other neurological disorders [1].These symptoms have been reported in