Advertisement

Neuroradiology

, Volume 59, Issue 2, pp 105–126 | Cite as

Imaging spectrum of central nervous system complications of hematopoietic stem cell and solid organ transplantation.

  • Andrés Server
  • Nuria Bargalló
  • Yngvar Fløisand
  • Jon Sponheim
  • Francesc Graus
  • John K. Hald
Continuing Education

Abstract

Neurologic complications are common after hematopoietic stem cell transplantation (HSCT) and solid organ transplantation (SOT) and affect 30–60% of transplant recipients. The aim of this article is to provide a practical imaging approach based on the timeline and etiology of CNS abnormalities, and neurologic complications related to transplantation of specific organs. The lesions will be classified based upon the interval from HSCT procedure: pre-engraftment period <30 days, early post-engraftment period 30–100 days, late post-engraftment period >100 days, and the interval from SOT procedure: postoperative phase 1–4 weeks, early posttransplant syndromes 1–6 months, late posttransplant syndromes >6 months. Further differentiation will be based on etiology: infections, drug toxicity, metabolic derangements, cerebrovascular complications, and posttransplantation malignancies. In addition, differentiation will be based on complications specific to the type of transplantation: allogeneic and autologous hematopoietic stem cells (HSC), heart, lung, kidney, pancreas, and liver. Thus, in this article we emphasize the strategic role of neuroradiology in the diagnosis and response to treatment by utilizing a methodical approach in the work up of patients with neurologic complications after transplantation.

Keywords

Brain Hematopoietic stem cell transplantation Solid organ transplantation Magnetic resonance imaging Neurologic complications 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.

References

  1. 1.
    Pruitt AA, Graus F, Rosenfeld MR (2013) Neurological complications of transplantation: part I: hematopoietic cell transplantation. Neurohospitalist 3:24–38PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Senzolo M, Ferronato C, Burra P (2009) Neurologic complications after solid organ transplantation. Transpl Int 22:269–278PubMedCrossRefGoogle Scholar
  3. 3.
    Rodriguez TE (2014) Neurologic complications of bone marrow transplantation. Handb Clin Neurol 121:1295–1304PubMedCrossRefGoogle Scholar
  4. 4.
    Uckan D, Cetin M, Yigitkanli I, Tezcan I, Tuncer M, Karasimav D, Oguz KK, Topçu M (2005) Life-threatening neurological complications after bone marrow transplantation in children. Bone Marrow Transplant 35:71–76PubMedCrossRefGoogle Scholar
  5. 5.
    Garrick R (2000) Neurological complications. In: Atkinson K et al (eds) Clinical bone marrow and blood stem cell transplantation. Cambridge University Press, Cambridge, pp 958–979Google Scholar
  6. 6.
    Wright AJ, Fishman JA (2014) Central nervous system syndromes in solid organ transplant recipients. Clin Infect Dis 59:1001–1011PubMedCrossRefGoogle Scholar
  7. 7.
    Dhar R, Young GB, Marotta P (2008) Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocrit Care 8:253–258PubMedCrossRefGoogle Scholar
  8. 8.
    Zivković SA, Eidelman BH, Bond G, Costa G, Abu-Elmagd KM (2010) The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation. Clin Transpl 24:164–168CrossRefGoogle Scholar
  9. 9.
    Pérez-Miralles F, Sánchez-Manso JC, Almenar-Bonet L, Sevilla-Mantecón T, Martínez-Dolz L, Vílchez-Padilla JJ (2005) Incidence of and risk factors for neurologic complications after heart transplantation. Transplant Proc 37:4067–4070PubMedCrossRefGoogle Scholar
  10. 10.
    Zivković S (2007) Neuroimaging and neurologic complications after organ transplantation. J Neuroimaging 17:110–123PubMedCrossRefGoogle Scholar
  11. 11.
    Guarino M, Benito-Leon J, Decruyenaere J, Schmutzhard E, Weissenborn K, Stracciari A, EFNS (2006) EFNS guidelines on management of neurological problems in liver transplantation. Eur J Neurol 13:2–9PubMedCrossRefGoogle Scholar
  12. 12.
    Dhar R, Human T (2011) Central nervous system complications after transplantation. Neurol Clin 29:943–972PubMedCrossRefGoogle Scholar
  13. 13.
    Stone TJ, Misra SP, McKinstry RC, Vo KD (2015) Imaging of central nervous system complications of hematopoietic stem cell transplant: a chronologic approach to pathology and implications for management. Neurographics 5:133–144CrossRefGoogle Scholar
  14. 14.
    Saiz A, Graus F (2010) Neurologic complications of hematopoietic cell transplantation. Semin Neurol 30:287–295PubMedCrossRefGoogle Scholar
  15. 15.
    Osborn A (2013) Hydrocephalus and CSF disorders. In: Osborn A (ed) Osborn’s Brain: imaging, pathology and anatomy. Amirsys Inc, pp 1005–1044Google Scholar
  16. 16.
    Graus F, Saiz A, Sierra J, Arbaiza D, Rovira M, Carreras E, Tolosa E, Rozman C (1996) Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study. Neurology 46:1004–1009PubMedCrossRefGoogle Scholar
  17. 17.
    Pomeranz S, Naparstek E, Ashkenazi E, Nagler A, Lossos A, Slavin S, Or R (1994) Intracranial haematomas following bone marrow transplantation. J Neurol 241:252–256PubMedCrossRefGoogle Scholar
  18. 18.
    Colosimo M, McCarthy N, Jayasinghe R, Morton J, Taylor K, Durrant S (2000) Diagnosis and management of subdural haematoma complicating bone marrow transplantation. Bone Marrow Transplant 25:549–552PubMedCrossRefGoogle Scholar
  19. 19.
    Coplin WM, Cochran MS, Levine SR, Crawford SW (2001) Stroke after bone marrow transplantation: frequency, aetiology and outcome. Brain 124:1043–1051PubMedCrossRefGoogle Scholar
  20. 20.
    Najima Y, Ohashi K, Miyazawa M, Nakano M, Kobayashi T, Yamashita T, Akiyama H, Sakamaki H (2009) Intracranial hemorrhage following allogeneic hematopoietic stem cell transplantation. Am J Hematol 84:298–301PubMedCrossRefGoogle Scholar
  21. 21.
    Campbell JN, Morris PP (2005) Cerebral vasculitis in graft-versus-host disease: a case report. AJNR Am J Neuroradiol 26:654–656PubMedGoogle Scholar
  22. 22.
    Chen-Plotkin AS, Vossel KA, Samuels MA, Chen MH (2007) Encephalopathy, stroke, and myocardial infarction with DMSO use in stem cell transplantation. Neurology 68:859–861PubMedCrossRefGoogle Scholar
  23. 23.
    Woywodt A, Haubitz M, Buchholz S, Hertenstein B (2004) Counting the cost: markers of endothelial damage in hematopoietic stem cell transplantation. Bone Marrow Transplant 34:1015–1023PubMedCrossRefGoogle Scholar
  24. 24.
    Chen BT, Ortiz AO, Dagis A, Torricelli C, Parker P, Openshaw H (2012) Brain imaging findings in symptomatic patients after allogeneic haematopoietic stem cell transplantation: correlation with clinical outcome. Eur Radiol 22:2273–2281PubMedCrossRefGoogle Scholar
  25. 25.
    Masetti R, Cordelli DM, Zama D, Vendemini F, Biagi C, Franzoni E, Pession A (2015) PRES in children undergoing hematopoietic stem cell or solid organ transplantation. Pediatrics 135:890–901PubMedCrossRefGoogle Scholar
  26. 26.
    Gocmen R, Ozgen B, Oguz KK (2007) Widening the spectrum of PRES: series from a tertiary care center. Eur J Radiol 62:454–459PubMedCrossRefGoogle Scholar
  27. 27.
    Bhatt A, Farooq MU, Majid A, Kassab M (2009) Chemotherapy-related posterior reversible leukoencephalopathy syndrome. Nat Clin Pract Neurol 5:163–169PubMedCrossRefGoogle Scholar
  28. 28.
    Nguyen MT, Virk IY, Chew L, Villano JL (2009) Extended use dexamethasone-associated posterior reversible encephalopathy syndrome with cisplatin-based chemotherapy. J Clin Neurosci 16:1688–1690PubMedCrossRefGoogle Scholar
  29. 29.
    Bartynski WS, Zeigler ZR, Shadduck RK, Lister J (2004) Pretransplantation conditioning influence on the occurrence of cyclosporine or FK-506 neurotoxicity in allogeneic bone marrow transplantation. AJNR Am J Neuroradiol 25:261–269PubMedGoogle Scholar
  30. 30.
    Chen S, Hu J, Xu L, Brandon D, Yu J, Zhang J (2015) Posterior reversible encephalopathy syndrome after transplantation: a review. Mol Neurobiol. doi: 10.1007/s12035-015-9560-0 Google Scholar
  31. 31.
    Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol 29:1043–1049PubMedCrossRefGoogle Scholar
  32. 32.
    Provenzale JM, Graham ML (1996) Reversible leukoencephalopathy associated with graft-versus-host disease: MR findings. AJNR Am J Neuroradiol 17:1290–1294PubMedGoogle Scholar
  33. 33.
    McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, Teksam M (2007) Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 189:904–912PubMedCrossRefGoogle Scholar
  34. 34.
    Hefzy HM, Bartynski WS, Boardman JF, Lacomis D (2009) Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 30:1371–1379PubMedCrossRefGoogle Scholar
  35. 35.
    Stevens CJ, Heran MK (2012) The many faces of posterior reversible encephalopathy syndrome. Br J Radiol 85:1566–1575PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Cordelli DM, Masetti R, Zama D, Gueraldi D, Rondelli R, Cottone C, Prete A, Pession A, Franzoni E (2014) Etiology, characteristics and outcome of seizures after pediatric hematopoietic stem cell transplantation. Seizure 23:140–145PubMedCrossRefGoogle Scholar
  37. 37.
    Siegal D, Keller A, Xu W, Bhuta S, Kim DH, Kuruvilla J, Lipton JH, Messner H, Gupta V (2007) Central nervous system complications after allogeneic hematopoietic stem cell transplantation: incidence, manifestations, and clinical significance. Biol Blood Marrow Transplant 13:1369–1379PubMedCrossRefGoogle Scholar
  38. 38.
    Iguchi A, Kobayashi R, Yoshida M, Kaneda M, Watanabe N, Cho Y, Arioka H, Naito H, Shikano T, Ishikawa Y (1999) Neurological complications after stem cell transplantation in childhood. Bone Marrow Transplant 24:647–652PubMedCrossRefGoogle Scholar
  39. 39.
    Bleggi-Torres LF, de Medeiros BC, Werner B, Neto JZ, Loddo G, Pasquini R, de Medeiros CR (2000) Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases. Bone Marrow Transplant 25:301–307PubMedCrossRefGoogle Scholar
  40. 40.
    Gillespie MB, O'Malley BW Jr, Francis HW (1998) An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host. Arch Otolaryngol Head Neck Surg 124:520–526PubMedCrossRefGoogle Scholar
  41. 41.
    DelGaudio JM, Swain RE Jr, Kingdom TT, Muller S, Hudgins PA (2003) Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 129:236–240PubMedCrossRefGoogle Scholar
  42. 42.
    Aribandi M, McCoy VA, Bazan C (2007) Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 27:1283–1296PubMedCrossRefGoogle Scholar
  43. 43.
    Dietrich U, Hettmann M, Maschke M, Doerfler A, Schwechheimer K, Forsting M (2001) Cerebral aspergillosis: comparison of radiological and neuropathologic findings in patients with bone marrow transplantation. Eur Radiol 11:1242–1249PubMedCrossRefGoogle Scholar
  44. 44.
    Nishiguchi T, Mochizuki K, Shakudo M, Takeshita T, Hino M, Inoue Y (2009) CNS complications of hematopoietic stem cell transplantation. AJR Am J Roentgenol 192:1003–1011PubMedCrossRefGoogle Scholar
  45. 45.
    Antonini G, Ceschin V, Morino S, Fiorelli M, Gragnani F, Mengarelli A, Iori AP, Arcese W (1998) Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study. Neurology 50:1441–1445PubMedCrossRefGoogle Scholar
  46. 46.
    Baek JH, Sohn SK, Kim DH, Kim JG, Lee HW, Park SP, Lee KB (2005) Wernicke's encephalopathy after allogeneic stem cell transplantation. Bone Marrow Transplant 35:829–830PubMedCrossRefGoogle Scholar
  47. 47.
    Sadighi Z, Sabin ND, Hayden R, Stewart E, Pillai A (2015) Diagnostic clues to human herpesvirus 6 encephalitis and Wernicke encephalopathy after pediatric hematopoietic cell transplantation. J Child Neurol 30:1307–1314PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Somech R, Doyle J (2007) Pseudotumor cerebri after allogeneic bone marrow transplant associated with cyclosporine a use for graft-versus-host disease prophylaxis. J Pediatr Hematol Oncol 29:66–68PubMedCrossRefGoogle Scholar
  49. 49.
    Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334:494–500PubMedCrossRefGoogle Scholar
  50. 50.
    Bartynski WS, Zeigler Z, Spearman MP, Lin L, Shadduck RK, Lister J (2001) Etiology of cortical and white matter lesions in cyclosporin-a and FK-506 neurotoxicity. AJNR Am J Neuroradiol 22:1901–1914PubMedGoogle Scholar
  51. 51.
    Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 29:1036–1042PubMedCrossRefGoogle Scholar
  52. 52.
    Kim SH, Kim W, Lee KW, Hong EK, Kim HJ (2011) Tumefactive demyelination, an uncommon form of tacrolimus neurotoxicity. Neurology 76:672–674PubMedCrossRefGoogle Scholar
  53. 53.
    Fischer SA (2008) Emerging viruses in transplantation: there is more to infection after transplant than CMV and EBV. Transplantation 86:1327–1339PubMedCrossRefGoogle Scholar
  54. 54.
    Tomblyn M, Young JA, Haagenson MD, Klein JP, Trachtenberg EA, Storek J, Spellman SR, Cooley S, Miller JS, Weisdorf DJ, CIBMTR Infection and Immune Reconstitution Working Committee (2010) Decreased infections in recipients of unrelated donor hematopoietic cell transplantation from donors with an activating KIR genotype. Biol Blood Marrow Transplant 16:1155–1161PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Ogata M, Fukuda T, Teshima T (2015) Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: what we do and do not know. Bone Marrow Transplant 50:1030–1036PubMedCrossRefGoogle Scholar
  56. 56.
    Ogata M, Satou T, Kadota J, Saito N, Yoshida T, Okumura H, Ueki T, Nagafuji K, Kako S, Uoshima N, Tsudo M, Itamura H, Fukuda T (2013) Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis 57:671–681PubMedCrossRefGoogle Scholar
  57. 57.
    Hill JA, Koo S, Guzman Suarez BB, Ho VT, Cutler C, Koreth J, Armand P, Alyea EP 3rd, Baden LR, Antin JH, Soiffer RJ, Marty FM (2012) Cord-blood hematopoietic stem cell transplant confers an increased risk for human herpesvirus-6-associated acute limbic encephalitis: a cohort analysis. Biol Blood Marrow Transplant 18:1638–1648PubMedCrossRefGoogle Scholar
  58. 58.
    Bhanushali MJ, Kranick SM, Freeman AF, Cuellar-Rodriguez JM, Battiwalla M, Gea-Banacloche JC, Hickstein DD, Pavletic S, Fahle G, Nath A (2013) Human herpes 6 virus encephalitis complicating allogeneic hematopoietic stem cell transplantation. Neurology 80:1494–1500PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Hill JA, Boeckh MJ, Sedlak RH, Jerome KR, Zerr DM (2014) Human herpesvirus 6 can be detected in cerebrospinal fluid without associated symptoms after allogeneic hematopoietic cell transplantation. J Clin Virol 61:289–292PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Vu T, Carrum G, Hutton G, Heslop HE, Brenner MK, Kamble R (2007) Human herpesvirus-6 encephalitis following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 39:705–709PubMedCrossRefGoogle Scholar
  61. 61.
    Shimazu Y, Kondo T, Ishikawa T, Yamashita K, Takaori-Kondo A (2013) Human herpesvirus-6 encephalitis during hematopoietic stem cell transplantation leads to poor prognosis. Transpl Infect Dis 15:195–201PubMedCrossRefGoogle Scholar
  62. 62.
    Scheurer ME, Pritchett JC, Amirian ES, Zemke NR, Lusso P, Ljungman P (2013) HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis. Bone Marrow Transplant 48:574–580PubMedCrossRefGoogle Scholar
  63. 63.
    Provenzale JM, vanLandingham KE, Lewis DV, Mukundan S Jr, White LE (2008) Extrahippocampal involvement in human herpesvirus 6 encephalitis depicted at MR imaging. Radiology 249:955–963PubMedCrossRefGoogle Scholar
  64. 64.
    Ogata M, Kikuchi H, Satou T, Kawano R, Ikewaki J, Kohno K, Kashima K, Ohtsuka E, Kadota J (2006) Human herpesvirus 6 DNA in plasma after allogeneic stem cell transplantation: incidence and clinical significance. J Infect Dis 193:68–79PubMedCrossRefGoogle Scholar
  65. 65.
    Muta T, Fukuda T, Harada M (2009) Human herpesvirus-6 encephalitis in hematopoietic SCT recipients in Japan: a retrospective multicenter study. Bone Marrow Transplant 43:583–585PubMedCrossRefGoogle Scholar
  66. 66.
    Seeley WW, Marty FM, Holmes TM, Upchurch K, Soiffer RJ, Antin JH, Baden LR, Bromfield EB (2007) Post-transplant acute limbic encephalitis: clinical features and relationship to HHV6. Neurology 69:156–165PubMedCrossRefGoogle Scholar
  67. 67.
    Wainwright MS, Martin PL, Morse RP, Lacaze M, Provenzale JM, Coleman RE, Morgan MA, Hulette C, Kurtzberg J, Bushnell C, Epstein L, Lewis DV (2001) Human herpesvirus 6 limbic encephalitis after stem cell transplantation. Ann Neurol 50:612–619PubMedCrossRefGoogle Scholar
  68. 68.
    Shintaku M, Kaneda D, Tada K, Katano H, Sata T (2010) Human herpes virus 6 encephalomyelitis after bone marrow transplantation: report of an autopsy case. Neuropathology 30:50–55PubMedCrossRefGoogle Scholar
  69. 69.
    Noguchi T, Yoshiura T, Hiwatashi A, Togao O, Yamashita K, Nagao E, Uchino A, Hasuo K, Atsumi K, Matsuura T, Kuroiwa T, Mihara F, Honda H, Kudo S (2010) CT and MRI findings of human herpesvirus 6-associated encephalopathy: comparison with findings of herpes simplex virus encephalitis. AJR Am J Roentgenol 194:754–760PubMedCrossRefGoogle Scholar
  70. 70.
    Kotton CN (2007) Zoonoses in solid-organ and hematopoietic stem cell transplant recipients. Clin Infect Dis 44:857–866PubMedCrossRefGoogle Scholar
  71. 71.
    Fricker-Hidalgo H, Bulabois CE, Brenier-Pinchart MP, Hamidfar R, Garban F, Brion JP, Timsit JF, Cahn JY, Pelloux H (2009) Diagnosis of toxoplasmosis after allogeneic stem cell transplantation: results of DNA detection and serological techniques. Clin Infect Dis 48:e9–e15PubMedCrossRefGoogle Scholar
  72. 72.
    Maschke M, Dietrich U, Prumbaum M, Kastrup O, Turowski B, Schaefer UW, Diener HC (1999) Opportunistic CNS infection after bone marrow transplantation. Bone Marrow Transplant 23:1167–1176PubMedCrossRefGoogle Scholar
  73. 73.
    Avivi I, Wittmann T, Henig I, Kra-Oz Z, Szwarcwort Cohen M, Zuckerman T, Horowitz NA, Benyamini N (2014) Development of multifocal leukoencephalopathy in patients undergoing allogeneic stem cell transplantation-can preemptive detection of John Cunningham virus be useful? Int J Infect Dis 26:107–109PubMedCrossRefGoogle Scholar
  74. 74.
    Kharfan-Dabaja MA, Ayala E, Greene J, Rojiani A, Murtagh FR, Anasetti C (2007) Two cases of progressive multifocal leukoencephalopathy after allogeneic hematopoietic cell transplantation and a review of the literature. Bone Marrow Transplant 39:101–107PubMedCrossRefGoogle Scholar
  75. 75.
    Gheuens S, Pierone G, Peeters P, Koralnik IJ (2010) Progressive multifocal leukoencephalopathy in individuals with minimal or occult immunosuppression. J Neurol Neurosurg Psychiatry 8:247–254CrossRefGoogle Scholar
  76. 76.
    Carson KR, Evens AM, Richey EA, Habermann TM, Focosi D, Seymour JF, Laubach J, Bawn SD, Gordon LI, Winter JN, Furman RR, Vose JM, Zelenetz AD, Mamtani R, Raisch DW, Dorshimer GW, Rosen ST, Muro K, Gottardi-Littell NR, Talley RL, Sartor O, Green D, Major EO, Bennett CL (2009) Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the research on adverse drug events and reports project. Blood 113:4834–4840PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Aksamit AJ Jr (2012) Progressive multifocal leukoencephalopathy. Continuum (Minneap Minn) 18:1374–1391Google Scholar
  78. 78.
    Tan K, Roda R, Ostrow L, McArthur J, Nath A (2009) PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids. Neurology 72:1458–1464PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Grauer O, Wolff D, Bertz H, Greinix H, Kühl JS, Lawitschka A, Lee SJ, Pavletic SZ, Holler E, Kleiter I (2010) Neurological manifestations of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: report from the consensus conference on clinical practice in chronic graft-versus-host disease. Brain 133:2852–2865PubMedCrossRefGoogle Scholar
  80. 80.
    Rouah E, Gruber R, Shearer W, Armstrong D, Hawkins EP (1988) Graft-versus-host disease in the central nervous system. A real entity? Am J Clin Pathol 89:543–546PubMedCrossRefGoogle Scholar
  81. 81.
    Kamble RT, Chang CC, Sanchez S, Carrum G (2007) Central nervous system graft-versus-host disease: report of two cases and literature review. Bone Marrow Transplant 39:49–52PubMedCrossRefGoogle Scholar
  82. 82.
    Jantunen E, Piilonen A, Volin L, Ruutu P, Parkkali T, Koukila-Kähkölä P, Ruutu T (2002) Radiologically guided fine needle lung biopsies in the evaluation of focal pulmonary lesions in allogeneic stem cell transplant recipients. Bone Marrow Transplant 29:353–356PubMedCrossRefGoogle Scholar
  83. 83.
    Rüping MJ, Vehreschild JJ, Cornely OA (2008) Patients at high risk of invasive fungal infections: when and how to treat. Drugs 68:1941–1962PubMedCrossRefGoogle Scholar
  84. 84.
    Pagano L, Ricci P, Montillo M, Cenacchi A, Nosari A, Tonso A, Cudillo L, Chierichini A, Savignano C, Buelli M, Melillo L, La Barbera EO, Sica S, Hohaus S, Bonini A, Bucaneve G, Del Favero A (1996) Localization of aspergillosis to the central nervous system among patients with acute leukemia: report of 14 cases. Gruppo Italiano Malattie Ematologiche dell’Adulto Infection Program. Clin Infect Dis 23:628–630PubMedCrossRefGoogle Scholar
  85. 85.
    DeLone DR, Goldstein RA, Petermann G, Salamat MS, Miles JM, Knechtle SJ, Brown WD (1999) Disseminated aspergillosis involving the brain: distribution and imaging characteristics. AJNR Am J Neuroradiol 20:1597–1604PubMedGoogle Scholar
  86. 86.
    Yuh WT, Nguyen HD, Gao F, Tali ET, Fisher DJ, Mayr NA, Mueller DP, Sato Y, Trigg ME, Gingrich R (1994) Brain parenchymal infection in bone marrow transplantation patients: CT and MR findings. AJR Am J Roentgenol 162:425–430PubMedCrossRefGoogle Scholar
  87. 87.
    Hoenigl M, Krause R (2013) Antifungal therapy of aspergillosis of the central nervous system and aspergillus endophthalmitis. Curr Pharm Des 19:3648–3668PubMedCrossRefGoogle Scholar
  88. 88.
    Cesaro S, Boaro MP, Pillon M, Calore E, Cermakova I, Perruccio K, Mengoli C, Messina C (2008) Immune reconstitution complicated by CMV retinitis in a pediatric patient who underwent haploidentical CD34+-selected hematopoietic stem cell transplant for acute lymphoblastic leukemia. Int J Hematol 88:145–148PubMedCrossRefGoogle Scholar
  89. 89.
    Arribas JR, Storch GA, Clifford DB, Tselis AC (1996) Cytomegalovirus encephalitis. Ann Intern Med 125:577–587PubMedCrossRefGoogle Scholar
  90. 90.
    Thurnher MM, Thurnher SA, Schindler E (1997) CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol 7:1091–1097PubMedCrossRefGoogle Scholar
  91. 91.
    Castellano-Sanchez AA, Li S, Qian J, Lagoo A, Weir E, Brat DJ (2004) Primary central nervous system posttransplant lymphoproliferative disorders. Am J Clin Pathol 121:246–253PubMedCrossRefGoogle Scholar
  92. 92.
    Dharnidharka VR, Webster AC, Martinez OM, Preiksaitis JK, Leblond V, Choquet S (2016) Post-transplant lymphoproliferative disorders. Nat Rev Dis Primers 2:15088. doi: 10.1038/nrdp.2015.88 PubMedCrossRefGoogle Scholar
  93. 93.
    Uhlin M, Wikell H, Sundin M, Blennow O, Maeurer M, Ringden O, Winiarski J, Ljungman P, Remberger M, Mattsson J (2014) Risk factors for Epstein-Barr virus-related post-transplant lymphoproliferative disease after allogeneic hematopoietic stem cell transplantation. Haematologica 99:346–352PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Pickhardt PJ, Siegel MJ, Hayashi RJ, Kelly M (2000) Posttransplantation lymphoproliferative disorder in children: clinical, histopathologic, and imaging features. Radiology 217:16–25PubMedCrossRefGoogle Scholar
  95. 95.
    Pickhardt PJ, Wippold FJ (1999) Neuroimaging in posttransplantation lymphoproliferative disorder. AJR Am J Roentgenol 172:1117–1121PubMedCrossRefGoogle Scholar
  96. 96.
    DeAngelis LM (1999) Primary central nervous system lymphoma. Curr Opin Neurol 12:687–691PubMedCrossRefGoogle Scholar
  97. 97.
    Lai R, Rosenblum MK, DeAngelis LM (2002) Primary CNS lymphoma: a whole-brain disease? Neurology 59:1557–1562PubMedCrossRefGoogle Scholar
  98. 98.
    Thurnher MM, Rieger A, Kleibl-Popov C, Settinek U, Henk C, Haberler C, Schindler E (2001) Primary central nervous system lymphoma in AIDS: a wider spectrum of CT and MRI findings. Neuroradiology 43:29–35PubMedCrossRefGoogle Scholar
  99. 99.
    Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES (2011) The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 117:5019–5032PubMedPubMedCentralCrossRefGoogle Scholar
  100. 100.
    Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socíe G, Travis LB, Horowitz MM, Witherspoon RP, Hoover RN, Sobocinski KA, Fraumeni JF Jr, Boice JD Jr (1997) Solid cancers after bone marrow transplantation. N Engl J Med 336:897–904PubMedCrossRefGoogle Scholar
  101. 101.
    Guermazi A, Miaux Y, Lafitte F, Zahar JR, Gluckman E (2003) CT and MR imaging of central nervous system effects of therapy in patients treated for hematological malignancies. Eur Radiol 13(Suppl 4):L202–L214PubMedCrossRefGoogle Scholar
  102. 102.
    Chapman SW, Wilson JP (1990) Nocardiosis in transplant recipients. Semin Respir Infect 5:74–79PubMedGoogle Scholar
  103. 103.
    Armstrong RW, Fung PC (1993) Brainstem encephalitis (rhombencephalitis) due to Listeria monocytogenes: case report and review. Clin Infect Dis 16:689–702PubMedCrossRefGoogle Scholar
  104. 104.
    Thurnher MM (2013) Meningitis and ventriculitis. In: Naidich T et al (eds) Imaging of the brain. Elsevier Saunders, Philadelphia, PA, pp 865–876Google Scholar
  105. 105.
    Chang KH, Han MH, Roh JK, Kim IO, Han MC, Kim CW (1990) Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT. AJNR Am J Neuroradiol 11:69–76PubMedGoogle Scholar
  106. 106.
    Kastrup O, Wanke I, Maschke M (2005) Neuroimaging of infections. NeuroRx 2:324–332PubMedPubMedCentralCrossRefGoogle Scholar
  107. 107.
    Moritani T (2009) Infectious disease. In: Moritani T et al (eds) Diffusion-weighted MR imaging of the brain. Springer-Verlag, Berlin Heidelberg, pp 193–223CrossRefGoogle Scholar
  108. 108.
    Castillo M (1999) Imaging brain abscesses with diffusion-weighted and other sequences. AJNR Am J Neuroradiol 20:1193–1194PubMedGoogle Scholar
  109. 109.
    Patel MP, Kute VB, Gumber MR, Shah PR, Patel HV, Dhananjay KL, Jain SH, Trivedi HL, Vanikar AV (2013) Successful treatment of Nocardia pneumonia with cytomegalovirus retinitis coinfection in a renal transplant recipient. Int Urol Nephrol 45:581–585PubMedCrossRefGoogle Scholar
  110. 110.
    Del Pozo JL, van de Beek D, Daly RC, Pulido JS, McGregor CG, Patel R (2009) Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study. Clin Transpl 23:484–489CrossRefGoogle Scholar
  111. 111.
    Ribalta T, Martinez AJ, Jares P, Muntané J, Miquel R, Claramonte X, Cardesa A (2002) Presence of occult cytomegalovirus infection in the brain after orthotopic liver transplantation. An autopsy study of 83 cases. Virchows Arch 440:166–171PubMedCrossRefGoogle Scholar
  112. 112.
    Connelly KP, DeWitt LD (1994) Neurologic complications of infectious mononucleosis. Pediatr Neurol 10:181–184PubMedCrossRefGoogle Scholar
  113. 113.
    Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ (2000) Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med 342:635–645PubMedCrossRefGoogle Scholar
  114. 114.
    Pruitt AA, Graus F, Rosenfeld MR (2013) Neurological complications of solid organ transplantation. Neurohospitalist 3:152–166PubMedPubMedCentralCrossRefGoogle Scholar
  115. 115.
    Yehia B, Davison A, Sisson S (2009) Transplant troubles. Am J Med 122:629–631PubMedCrossRefGoogle Scholar
  116. 116.
    Mateen FJ, Muralidharan R, Carone M, van de Beek D, Harrison DM, Aksamit AJ, Gould MS, Clifford DB, Nath A (2011) Progressive multifocal leukoencephalopathy in transplant recipients. Ann Neurol 70:305–322PubMedPubMedCentralCrossRefGoogle Scholar
  117. 117.
    DeSalvo D, Roy-Chaudhury P, Peddi R, Merchen T, Konijetti K, Gupta M, Boardman R, Rogers C, Buell J, Hanaway M, Broderick J, Smith R, Woodle ES (2004) West Nile virus encephalitis in organ transplant recipients: another high-risk group for meningoencephalitis and death. Transplantation 77:466–469PubMedCrossRefGoogle Scholar
  118. 118.
    Burton EC, Burns DK, Opatowsky MJ, El-Feky WH, Fischbach B, Melton L, Sanchez E, Randall H, Watkins DL, Chang J, Klintmalm G (2005) Rabies encephalomyelitis: clinical, neuroradiological, and pathological findings in 4 transplant recipients. Arch Neurol 62:873–882PubMedCrossRefGoogle Scholar
  119. 119.
    Singh N, Dromer F, Perfect JR, Lortholary O (2008) Cryptococcosis in solid organ transplant recipients: current state of the science. Clin Infect Dis 47:1321–1327PubMedPubMedCentralCrossRefGoogle Scholar
  120. 120.
    Singh N, Lortholary O, Dromer F, Alexander BD, Gupta KL, John GT, del Busto R, Klintmalm GB, Somani J, Lyon GM, Pursell K, Stosor V, Munoz P, Limaye AP, Kalil AC, Pruett TL, Garcia-Diaz J, Humar A, Houston S, House AA, Wray D, Orloff S, Dowdy LA, Fisher RA, Heitman J, Wagener MM, Husain S, Cryptococcal Collaborative Transplant Study Group (2008) Central nervous system cryptococcosis in solid organ transplant recipients: clinical relevance of abnormal neuroimaging findings. Transplantation 86:647–651PubMedPubMedCentralCrossRefGoogle Scholar
  121. 121.
    Wu G, Vilchez RA, Eidelman B, Fung J, Kormos R, Kusne S (2002) Cryptococcal meningitis: an analysis among 5,521 consecutive organ transplant recipients. Transpl Infect Dis 4:183–188PubMedCrossRefGoogle Scholar
  122. 122.
    Christophe C, Azzi N, Bouché B, Dan B, Levivier M, Ferster A (1999) Magnetic resonance imaging and angiography in cerebral fungal vasculitis. Neuropediatrics 30:218–220PubMedCrossRefGoogle Scholar
  123. 123.
    Legris T, Massad M, Purgus R, Vacher-Coponat H, Ranque S, Girard N, Berland Y, Moal V (2011) Immune reconstitution inflammatory syndrome mimicking relapsing cryptococcal meningitis in a renal transplant recipient. Transpl Infect Dis 13:303–308PubMedCrossRefGoogle Scholar
  124. 124.
    Singh N, Perfect JR (2007) Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis 7:395–401PubMedCrossRefGoogle Scholar
  125. 125.
    Clay AS, Hainline BE (2007) Hyperammonemia in the ICU. Chest 132:1368–1378PubMedCrossRefGoogle Scholar
  126. 126.
    U-King-Im JM, Yu E, Bartlett E, Soobrah R, Kucharczyk W (2011) Acute hyperammonemic encephalopathy in adults: imaging findings. AJNR Am J Neuroradiol 32:413–418PubMedCrossRefGoogle Scholar
  127. 127.
    Rosario M, McMahon K, Finelli PF (2013) Diffusion-weighted imaging in acute hyperammonemic encephalopathy. Neurohospitalist 3:125–130PubMedPubMedCentralCrossRefGoogle Scholar
  128. 128.
    Takanashi J, Barkovich AJ, Cheng SF, Weisiger K, Zlatunich CO, Mudge C, Rosenthal P, Tuchman M, Packman S (2003) Brain MR imaging in neonatal hyperammonemic encephalopathy resulting from proximal urea cycle disorders. AJNR Am J Neuroradiol 24:1184–1187PubMedGoogle Scholar
  129. 129.
    Sureka J, Jakkani RK, Panwar S (2012) MRI findings in acute hyperammonemic encephalopathy resulting from decompensated chronic liver disease. Acta Neurol Belg 112:221–223PubMedCrossRefGoogle Scholar
  130. 130.
    McKinney AM, Lohman BD, Sarikaya B, Uhlmann E, Spanbauer J, Singewald T, Brace JR (2010) Acute hepatic encephalopathy: diffusion-weighted and fluid-attenuated inversion recovery findings, and correlation with plasma ammonia level and clinical outcome. AJNR Am J Neuroradiol 31:1471–1479PubMedCrossRefGoogle Scholar
  131. 131.
    Chang SH, Lim CS, Low TS, Chong HT, Tan SY (2001) Cyclosporine-associated encephalopathy: a case report and literature review. Transplant Proc 33:3700–3701PubMedCrossRefGoogle Scholar
  132. 132.
    Parvex P, Pinsk M, Bell LE, O'Gorman AM, Patenaude YG, Gupta IR (2001) Reversible encephalopathy associated with tacrolimus in pediatric renal transplants. Pediatr Nephrol 16:537–542PubMedCrossRefGoogle Scholar
  133. 133.
    Inoha S, Inamura T, Nakamizo A, Ikezaki K, Amano T, Fukui M (2002) Magnetic resonance imaging in cases with encephalopathy secondary to immunosuppressive agents. J Clin Neurosci 9:305–307PubMedCrossRefGoogle Scholar
  134. 134.
    Furukawa M, Terae S, Chu BC, Kaneko K, Kamada H, Miyasaka K (2001) MRI in seven cases of tacrolimus (FK-506) encephalopathy: utility of FLAIR and diffusion-weighted imaging. Neuroradiology 43:615–621PubMedCrossRefGoogle Scholar
  135. 135.
    Avila JD, Živković S (2015) The neurology of solid organ transplantation. Curr Neurol Neurosci Rep 15:38PubMedCrossRefGoogle Scholar
  136. 136.
    Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Al-Dadah AS, Meyers BF, Pasque MK, Ewald GA, Moon MR, Moazami N (2007) Significance of neurologic complications in the modern era of cardiac transplantation. Ann Thorac Surg 83:1684–1690PubMedCrossRefGoogle Scholar
  137. 137.
    Jarquin-Valdivia AA, Wijdicks EF, McGregor C (1999) Neurologic complications following heart transplantation in the modern era: decreased incidence, but postoperative stroke remains prevalent. Transplant Proc 31:2161–2162PubMedCrossRefGoogle Scholar
  138. 138.
    van de Beek D, Kremers W, Daly RC, Edwards BS, Clavell AL, McGregor CG, Wijdicks EF (2008) Effect of neurologic complications on outcome after heart transplant. Arch Neurol 65:226–231PubMedGoogle Scholar
  139. 139.
    Oliveras A, Roquer J, Puig JM, Rodríguez A, Mir M, Orfila MA, Masramon J, Lloveras J (2003) Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcome. Clin Transpl 17:1–8CrossRefGoogle Scholar
  140. 140.
    Wijdicks EF, Torres VE, Schievink WI, Sterioff S (1999) Cerebral hemorrhage in recipients of renal transplantation. Mayo Clin Proc 74:1111–1112PubMedCrossRefGoogle Scholar
  141. 141.
    Wijdicks EF, de Groen PC, Wiesner RH, Krom RA (1995) Intracerebral hemorrhage in liver transplant recipients. Mayo Clin Proc 70:443–446PubMedCrossRefGoogle Scholar
  142. 142.
    Gilden DH, Mahalingam R, Cohrs RJ, Kleinschmidt-DeMasters BK, Forghani B (2002) The protean manifestations of varicella-zoster virus vasculopathy. J Neurovirol Suppl 2:75–79CrossRefGoogle Scholar
  143. 143.
    Penn I (2000) Some problems with posttransplant lymphoproliferative disease. Transplantation 69:705–706PubMedCrossRefGoogle Scholar
  144. 144.
    Geissler EK (2015) Post-transplantation malignancies: here today, gone tomorrow? Nat Rev Clin Oncol 12:705–717PubMedCrossRefGoogle Scholar
  145. 145.
    Nalesnik MA, Woodle ES, Dimaio JM, Vasudev B, Teperman LW, Covington S, Taranto S, Gockerman JP, Shapiro R, Sharma V, Swinnen LJ, Yoshida A, Ison MG (2011) Donor-transmitted malignancies in organ transplantation: assessment of clinical risk. Am J Transplant 11:1140–1147PubMedCrossRefGoogle Scholar
  146. 146.
    Cavaliere R, Petroni G, Lopes MB, Schiff D, International Primary Central Nervous System Lymphoma Collaborative Group (2010) Primary central nervous system post-transplantation lymphoproliferative disorder: an International Primary Central Nervous System Lymphoma Collaborative Group report. Cancer 116:863–870PubMedPubMedCentralCrossRefGoogle Scholar
  147. 147.
    Evens AM, Choquet S, Kroll-Desrosiers AR, Jagadeesh D, Smith SM, Morschhauser F, Leblond V, Roy R, Barton B, Gordon LI, Gandhi MK, Dierickx D, Schiff D, Habermann TM, Trappe R (2013) Primary CNS posttransplant lymphoproliferative disease (PTLD): an international report of 84 cases in the modern era. Am J Transplant 13:1512–1522PubMedCrossRefGoogle Scholar
  148. 148.
    Buell JF, Gross TG, Hanaway MJ, Trofe J, Roy-Chaudhury P, First MR, Woodle ES (2005) Posttransplant lymphoproliferative disorder: significance of central nervous system involvement. Transplant Proc 37:954–955PubMedCrossRefGoogle Scholar
  149. 149.
    Kinch A, Cavelier L, Bengtsson M, Baecklund E, Enblad G, Backlin C, Thunberg U, Sundström C, Pauksens K (2014) Donor or recipient origin of posttransplant lymphoproliferative disorders following solid organ transplantation. Am J Transplant 14:2838–2845PubMedCrossRefGoogle Scholar
  150. 150.
    Snanoudj R, Durrbach A, Leblond V, Caillard S, Hurault De Ligny B, Noel C, Rondeau E, Moulin B, Mamzer-Bruneel MF, Lacroix C, Charpentier B (2003) Primary brain lymphomas after kidney transplantation: presentation and outcome. Transplantation 76:930–937PubMedCrossRefGoogle Scholar
  151. 151.
    Phan TG, O'Neill BP, Kurtin PJ (2000) Posttransplant primary CNS lymphoma. Neuro-Oncology 2:229–238PubMedPubMedCentralCrossRefGoogle Scholar
  152. 152.
    Schiff D, O'Neill B, Wijdicks E, Antin JH, Wen PY (2001) Gliomas arising in organ transplant recipients: an unrecognized complication of transplantation? Neurology 57:1486–1488PubMedCrossRefGoogle Scholar
  153. 153.
    Fatt MA, Horton KM, Fishman EK (2008) Transmission of metastatic glioblastoma multiforme from donor to lung transplant recipient. J Comput Assist Tomogr 32:407–409PubMedCrossRefGoogle Scholar
  154. 154.
    Penn I (1996) Malignant melanoma in organ allograft recipients. Transplantation 61:274–278PubMedCrossRefGoogle Scholar
  155. 155.
    Muñoz P, Valerio M, Palomo J, Fernández-Yáñez J, Fernández-Cruz A, Guinea J, Bouza E (2010) Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore) 89:166–175CrossRefGoogle Scholar
  156. 156.
    Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D, Wijdicks EF (2010) Neurological complications following adult lung transplantation. Am J Transplan 10:908–914CrossRefGoogle Scholar
  157. 157.
    Zivković SA, Jumaa M, Barisić N, McCurry K (2009) Neurologic complications following lung transplantation. J Neurol Sci 280:90–93PubMedCrossRefGoogle Scholar
  158. 158.
    Adams HP Jr, Dawson G, Coffman TJ, Corry RJ (1986) Stroke in renal transplant recipients. Arch Neurol 43:113–115PubMedCrossRefGoogle Scholar
  159. 159.
    Hollenbeak CS, Todd MM, Billingsley EM, Harper G, Dyer AM, Lengerich EJ (2005) Increased incidence of melanoma in renal transplantation recipients. Cancer 104:1962–1967PubMedCrossRefGoogle Scholar
  160. 160.
    Evens AM, Roy R, Sterrenberg D, Moll MZ, Chadburn A, Gordon LI (2010) Post-transplantation lymphoproliferative disorders: diagnosis, prognosis, and current approaches to therapy. Curr Oncol Rep 12:383–394PubMedCrossRefGoogle Scholar
  161. 161.
    Ponticelli C, Campise MR (2005) Neurological complications in kidney transplant recipients. J Nephrol 18:521–528PubMedGoogle Scholar
  162. 162.
    Kiok MC (1988) Neurologic complications of pancreas transplants. Neurol Clin 6:367–376PubMedGoogle Scholar
  163. 163.
    Kim JM, Jung KH, Lee ST, Chu K, Roh JK (2015) Central nervous system complications after liver transplantation. J Clin Neurosci 22:1355–1359PubMedCrossRefGoogle Scholar
  164. 164.
    Saner FH, Gensicke J, Olde Damink SW, Pavlaković G, Treckmann J, Dammann M, Kaiser GM, Sotiropoulos GC, Radtke A, Koeppen S, Beckebaum S, Cicinnati V, Nadalin S, Malagó M, Paul A, Broelsch CE (2010) Neurologic complications in adult living donor liver transplant patients: an underestimated factor? J Neurol 257:253–258PubMedCrossRefGoogle Scholar
  165. 165.
    de Groen PC, Aksamit AJ, Rakela J, Forbes GS, Krom RA (1987) Central nervous system toxicity after liver transplantation. The role of cyclosporine and cholesterol. N Engl J Med 317:861–866PubMedCrossRefGoogle Scholar
  166. 166.
    Ghaus N, Bohlega S, Rezeig M (2001) Neurological complications in liver transplantation. J Neurol 248:1042–1048PubMedCrossRefGoogle Scholar
  167. 167.
    Zivković SA (2013) Neurologic complications after liver transplantation. World J Hepatol 5:409–416PubMedPubMedCentralCrossRefGoogle Scholar
  168. 168.
    Wijdicks EF, Hocker SE (2014) Neurologic complications of liver transplantation. Handb Clin Neurol 121:1257–1266PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Section of Neuroradiology, Department of Radiology and Nuclear MedicineOslo University Hospital-RikshospitaletOsloNorway
  2. 2.Section of Neuroradiology, Department of Radiology, Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
  3. 3.Resonance Magnetic Image Core FacilityInstitut d’investigacions Biomédiques August Pi i Sunyer (IDIBARS)BarcelonaSpain
  4. 4.Department of HematologyOslo University Hospital-RikshospitaletOsloNorway
  5. 5.Section of Gastroenterology, Department of Transplantation MedicineOslo University Hospital-RikshospitaletOsloNorway
  6. 6.Department of Neurology, Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
  7. 7.Neuroimmunology ProgramInstitut d’investigacions Biomédiques August Pi i Sunyer (IDIBARS)BarcelonaSpain
  8. 8.Faculty of MedicineUniversity of OsloOsloNorway

Personalised recommendations