[ISPHLT-OS1-1] Reversible cerebral vasoconstriction syndrome after pediatric heart transplantation
Neurological complications are an important cause of morbidity and mortality in patients after heart transplantation. Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but increasingly recognized syndrome characterized by diffuse segmental constriction of cerebral arteries with thunderclap headache that can lead to severe neurological complications such as stroke and seizure. Here, we report three cases of RCVS, induced by tacrolimus in adolescent patients (13, 16, 17 years old) after heart transplantation. We demonstrate the characteristic magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) images in this presentation. All cases have thunderclap headache as the typical clinical symptom. All patients underwent heart transplantation after a long waiting period and developed headache within a month of transplantation. Two of them were implanted ventricular assist device. Diagnosis of RCVS was confirmed by repeated MRI scans. Tacrolimus was suspected as the causal agent in all cases, and the change of the immunosuppressant to cyclosporine and administration of calcium channel blocker were highly effective. We should suspect RCVS and should immediately conduct MRI and MRA even in pediatric patients when they claim thunderclap headache after heart transplantation.