Multifocal narrowing and dilation of intracranial vessels (1-month follow-up)

One month after initial presentation, there is irregularity of multiple intracranial branches including the distal internal carotid arteries, distal vertebral arteries, basilar artery, and proximal segments of the anterior, middle, and posterior cerebral arteries bilaterally. The noted irregularities have improved since the initial examination. CT angiogram findings were consistent with improvement of the intracranial vasculopathy. Our clinical impression was that our patient had possible PRES as well as reversible segmental cerebral vasoconstriction (Call-Fleming syndrome), possibly due to treatment with cyclosporine. Tacrolimus neurotoxicity has also been associated with PRES. (Contributed by Dr. Jose Biller.)