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FIG. 4. CT scans obtained at the time of toxic reaction shows areas of low attenuation extending centrally from the frontal lobe to the parietal region, involving the white matter and projecting to the cortical surface. Hemorrhages are noted in the right frontal lobe and right parietal area (arrows). The brain abnormalities are severe and appear to lie in a region that could easily coincide with the boundary between anterior cerebral and middle cerebral territories. Images were obtained in a patient (case 11), conditioned for transplantation with cyclophosphamide and busulfan, who presented with generalized tonic-clonic seizure activity 8 d after transplantation. At the onset of toxic reaction, the patient had grade 3 BMT-related TM that rapidly worsened to grade 4. The cyclosporin level at the time of toxic reaction was within the normal therapeutic range. Her baseline blood pressure was 110/70 mm Hg, which increased to 152/96 mm Hg at toxic reaction
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