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FIG. 5. Images in a patient (case 18), who was conditioned for transplantation with cyclophosphamide, thiotepa, and busulfan and who presented with binocular cortical blindness 15 d after transplantation. At the time of toxic reaction, the patient had grade 3 BMT-related TM, and the CsA level was within the normal therapeutic range. Her baseline blood pressure was 150/88 mm Hg, which increased to 180/100 mm Hg at toxic reaction.
A, T2-weighted axial MR image (2500/84/2) shows areas of mixed cortical and white matter signal intensity abnormalities in the occipital pole region bilaterally. Abnormalities are greater on the left (arrow). At autopsy, vasogenic edema was present in the bilateral occipital lobes, with evidence of ischemic neuronal necrosis in the cortex at the occipital watershed region.
B, T2-weighted sagittal MR image (2500/84/2) clearly shows signal intensity abnormality in the calcarine region (arrow).
C, 3D TOF MR angiogram, collapsed view (46/6.9/1), shows vessel narrowing and irregularity in the left middle cerebral artery (curved arrow) and bilateral posterior cerebral arteries; these findings are more striking on the left (straight arrow).
D, Postprocessed 3D TOF MR angiogram with background noise elimination shows a string-of-beads appearance in the posterior cerebral arteries; the finding is more severe on the left (arrow). At autopsy, these vessels appeared normal, without evidence of vasculitis.
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