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AJNR - American Journal of Neuroradiology

Published ahead of print on October 14, 2008
doi: 10.3174/ajnr.A1311

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American Journal of Neuroradiology 30:588-590, March 2009
© 2009 American Society of Neuroradiology

Case Report
BRAIN

Reversible Encephalopathy after Cardiac Transplantation: Histologic Evidence of Endothelial Activation, T-Cell Specific Trafficking, and Vascular Endothelial Growth Factor Expression

C. Horbinski^a, W.S. Bartynski^b, E. Carson-Walter^e, R.L. Hamilton^a, H.P. Tan^c and S. Cheng^a,d

^a Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa
^b Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
^c Thomas Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
^d Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
^e Department of Neurosurgery, University of Rochester, Rochester, NY

Please address correspondence to Walter S. Bartynski, MD, Department of Radiology, Division of Neuroradiology, Presbyterian University Hospital, University of Pittsburgh, 200 Lothrop St, D132, Pittsburgh, PA 15213; e-mail: bartynskiws{at}upmc.edu

SUMMARY: Reversible encephalopathy after transplantation is well recognized. The condition is commonly thought to be related to immune suppression, and a characteristic brain imaging pattern is typically recognized with vasogenic edema in the parietal and occipital regions, typically termed posterior reversible encephalopathy syndrome (PRES). We report the case of a patient with reversible encephalopathy after cardiac transplantation with brain biopsy evidence of endothelial activation, selective intravascular/perivascular T-cell trafficking, and VEGF expression in astrocytes, neurons, and the endothelium.

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