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Spontaneous Intracranial Hypotension-Hypovolemia Associated With Tacrolimus

Authors

  • Andrew H. Ahn MD, PhD,

    1. From the Department of Neurology, University of California San Francisco, San Francisco, CA, USA (A.H. Ahn and B.D. Berman); Department of Radiology, Neuroradiology Section, University of California San Francisco, San Francisco, CA, USA (W.P. Dillon).
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  • Brian D. Berman MD,

    1. From the Department of Neurology, University of California San Francisco, San Francisco, CA, USA (A.H. Ahn and B.D. Berman); Department of Radiology, Neuroradiology Section, University of California San Francisco, San Francisco, CA, USA (W.P. Dillon).
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  • William P. Dillon MD

    1. From the Department of Neurology, University of California San Francisco, San Francisco, CA, USA (A.H. Ahn and B.D. Berman); Department of Radiology, Neuroradiology Section, University of California San Francisco, San Francisco, CA, USA (W.P. Dillon).
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  • Conflict of Interest: The authors report no conflicts of interest. Patient has provided written consent.

A.H. Ahn, University of Florida Department of Neurology, 100 South Newell Dr., Box 100236, McKnight Brain Institute L3-100, Gainesville, FL 32610, USA.

Abstract

There is little precedent for a medication-induced spontaneous intracranial hypotension/cerebrospinal fluid (CSF) hypovolemia (SIH). This case history of a woman with low CSF pressure, orthostatic headache, and radiographic findings consistent with SIH but without a detectable leak was notable for its association, both onset and resolution, with the use of the calcineurin inhibitor tacrolimus (FK506). A literature review for potential causes of a tacrolimus-induced CSF hypotension suggests many potential mechanisms of action, including effects on blood brain barrier and dural compliance, and supports further vigilance for this condition in the medically complex setting of tacrolimus use.

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