Cerebral manifestations in liver disease and transplantation

Posterior Reversible Encephalopathy Syndrome After Transplantation: a Review

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease. Recently, an increase in the number of transplantations has led to more cases being associated with PRES than what was previously reported. Calcineurin inhibitors (CNIs) are major risk factors for PRES in posttransplantation patients. The mechanisms of the development of PRES remain to be unclear. The typical clinical symptoms of PRES include seizures, acute encephalopathy syndrome, and visual symptoms. The hyperintense signal on fluid-attenuated inversion recovery image is the characteristic of the imaging appearance in these patients. In addition, other abnormal signals distributed in multiple locations are also reported in some atypical cases. Unfortunately, PRES is often not recognized or diagnosed too late due to complicated differential diagnoses, such as ischemic stroke, progressive multifocal leukoencephalopathy, and neurodegenerative diseases. Thus, this review emphasizes the importance of considering the possibility of PRES when neurological disturbances appear after solid organ transplantation or hematopoietic cell transplantation. Moreover, this review demonstrates the molecular mechanisms of PRES associated with CNIs after transplantation, which aims to help clinicians further understand PRES in the transplantation era.

Evaluation of neurological complications in pediatric liver transplant recipients: MRI versus CT

With the aim of guiding choice of the best imaging modality for specific clinical conditions, we retrospectively evaluated neuroradiological findings in pediatric liver transplant recipients with neurological complications. Computed tomography (CT) was used to examine 31 patients with acute neurological symptoms after liver transplantation, and magnetic resonance imaging (MRI) was used for 35 such patients. A total of 16 patients belonged to both groups. Headache was the most common symptom in patients with computed tomography; seizure was most common among patients with magnetic resonance imaging. Magnetic resonance imaging detected additional abnormalities in 5 patients presenting with seizures whose computed tomography results were normal or insufficient to explain the clinical picture. In conclusion, liver transplant recipients with seizure should undergo magnetic resonance imaging emergently when possible; omitting computed tomography. Choice of imaging modality should be directed by nature of symptoms and time interval between transplantation and symptom onset.