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Mula-Hussain L, Lum K, Alaslani O, Bebedjian R, Grimard L, Sinclair J, Dos Santos MP. Perimesencephalic subarachnoid hemorrhage as a rare delayed complication of radiation therapy in a patient with parotid basaloid squamous cell carcinoma. J Med Imaging Radiat Sci 2024; 55:354-359. [PMID: 38418293 DOI: 10.1016/j.jmir.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated with radiation therapy. Following twenty years of continuous remission, our patient presented with an acute perimesencephalic subarachnoid hemorrhage. The cause of the acute perimesencephalic subarachnoid hemorrhage was a delayed complication of radiation therapy.
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Affiliation(s)
- Layth Mula-Hussain
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Keanu Lum
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Ottawa, ON, Canada
| | - Ohoud Alaslani
- Department of Radiology, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Razmik Bebedjian
- Department of Medicine, Neurology Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Laval Grimard
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital; Ottawa, ON, Canada
| | - John Sinclair
- Department of Surgery, Neurosurgery Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Marlise P Dos Santos
- Department of Radiology, Radiation Oncology and Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Associate Professor of Radiology, University of Ottawa; Clinician Investigator, Neurosciences Program, Ottawa Hospital Research Institute; Scientist, Brain and Mind Research Institute; Ottawa ON, Canada.
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Nagy G, McCutcheon BA, Giannini C, Link MJ, Pollock BE. Radiation-Induced Cavernous Malformations After Single-Fraction Meningioma Radiosurgery. Oper Neurosurg (Hagerstown) 2019; 15:207-212. [PMID: 29281070 DOI: 10.1093/ons/opx254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/26/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a commonly performed procedure for patients with intracranial meningiomas. OBJECTIVE To describe the clinical features of patients with radiation-induced cavernous malformations (RICM) after single-fraction meningioma SRS. METHODS Retrospective study of patients having single-fraction SRS for intracranial meningioma at our center from 1990 through 2009, and 1 patient who had single-fraction SRS elsewhere. Patients were excluded if they refused research authorization (n = 7), had a World Health Organization Grade II or III meningioma (n = 65), had a genetic predisposition for tumor development (n = 52), had prior or concurrent radiation therapy (n = 49), or had less than 2 yr of magnetic resonance imaging follow-up after SRS (n = 77). The median follow-up of the remaining 426 patients was 7.9 yr (range, 2-24.9). RESULTS Three RICM (0.7%) were identified at 2, 10, and 21 yr after SRS. Two patients were asymptomatic, whereas 1 patient had a brainstem hemorrhage causing facial weakness and numbness. The risk of developing an RICM after SRS was 0.2% at 5 yr and 0.9% at 15 yr. All patients were observed and remained stable without additional bleeding in follow-up of 7, 12.8, and 2 yr, respectively. A fourth patient developed progressive neurological dysfunction starting 7 yr after SRS at another center and was treated for several years with bevacizumab without improvement. Surgical resection was performed 11.5 yr after SRS and histologic examination was consistent with an RICM. CONCLUSION The risk of RICM after single-fraction SRS for intracranial meningiomas is very low, but the latency period noted until their detection emphasizes the need for extended imaging follow-up after SRS of benign lesions.
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Affiliation(s)
- Gábor Nagy
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Brandon A McCutcheon
- Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Caterina Giannini
- Department of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael J Link
- Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Bruce E Pollock
- Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities. Curr Oncol Rep 2019; 21:66. [PMID: 31218455 DOI: 10.1007/s11912-019-0818-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Cerebral radiation necrosis (CRN) is a major dose-limiting adverse event of radiotherapy. The incidence rate of RN varies with the radiotherapy modality, total dose, dose fractionation, and the nature of the lesion being targeted. In addition to these known and controllable features, there is a stochastic component to the occurrence of CRN-the genetic profile of the host or the lesion and their role in the development of CRN. RECENT FINDINGS Recent studies provide some insight into the genetic mechanisms underlying radiation-induced brain injury. In addition to these incompletely understood host factors, the diagnostic criteria for CRN using structural and functional imaging are also not clear, though multiple structural and functional imaging modalities exist, a combination of which may prove to be the ideal diagnostic imaging approach. As the utilization of novel molecular therapies and immunotherapy increases, the incidence of CNR is expected to increase and its diagnosis will become more challenging. Tissue biopsies can be insensitive and suffer from sampling biases and procedural risks. Liquid biopsies represent a promising, accurate, and non-invasive diagnostic strategy, though this modality is currently in its infancy. A better understanding of the pathogenesis of CRN will expand and optimize the diagnosis and management of CRN by better utilizing existing treatment options including bevacizumab, pentoxifylline, hyperbaric oxygen therapy, and laser interstitial thermal therapy.
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Vilela MD, Longstreth WT, Pedrosa HA, Gil GO, Duarte JM, Filho MAD. Progressively Enlarging Cerebellar Hematoma Concurrent with T-DM1 Treatment. World Neurosurg 2018; 111:109-114. [DOI: 10.1016/j.wneu.2017.12.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/08/2023]
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5
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Kim TH, Yun TJ, Park CK, Kim TM, Kim JH, Sohn CH, Won JK, Park SH, Kim IH, Choi SH. Combined use of susceptibility weighted magnetic resonance imaging sequences and dynamic susceptibility contrast perfusion weighted imaging to improve the accuracy of the differential diagnosis of recurrence and radionecrosis in high-grade glioma patients. Oncotarget 2017; 8:20340-20353. [PMID: 27823971 PMCID: PMC5386766 DOI: 10.18632/oncotarget.13050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/28/2016] [Indexed: 01/14/2023] Open
Abstract
Purpose was to assess predictive power for overall survival (OS) and diagnostic performance of combination of susceptibility-weighted MRI sequences (SWMRI) and dynamic susceptibility contrast (DSC) perfusion-weighted imaging (PWI) for differentiation of recurrence and radionecrosis in high-grade glioma (HGG). We enrolled 51 patients who underwent radiation therapy or gamma knife surgeryfollowed by resection for HGG and who developed new measurable enhancement more than six months after complete response. The lesions were confirmed as recurrence (n = 32) or radionecrosis (n = 19). The mean and each percentile value from cumulative histograms of normalized CBV (nCBV) and proportion of dark signal intensity on SWMRI (proSWMRI, %) within enhancement were compared. Multivariate regression was performed for the best differentiator. The cutoff value of best predictor from ROC analysis was evaluated. OS was determined with Kaplan-Meier method and log-rank test. Recurrence showed significantly lower proSWMRI and higher mean nCBV and 90th percentile nCBV (nCBV90) than radionecrosis. Regression analysis revealed both nCBV90 and proSWMRI were independent differentiators. Combination of nCBV90 and proSWMRI achieved 71.9% sensitivity (23/32), 100% specificity (19/19) and 82.3% accuracy (42/51) using best cut-off values (nCBV90 > 2.07 and proSWMRI≤15.76%) from ROC analysis. In subgroup analysis, radionecrosis with nCBV > 2.07 (n = 5) showed obvious hemorrhage (proSWMRI > 32.9%). Patients with nCBV90 > 2.07 and proSWMRI≤15.76% had significantly shorter OS. In conclusion, compared with DSC PWI alone, combination of SWMRI and DSC PWI have potential to be prognosticator for OS and lower false positive rate in differentiation of recurrence and radionecrosis in HGG who develop new measurable enhancement more than six months after complete response.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Il Han Kim
- Department of Radiation Oncology, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea
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Cutsforth-Gregory JK, Lanzino G, Link MJ, Brown RD, Flemming KD. Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort. J Neurosurg 2015; 122:1214-22. [PMID: 25699412 DOI: 10.3171/2015.1.jns141452] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this study was to characterize the clinical features of radiation-induced cavernous malformations (RICMs). METHODS The authors retrospectively reviewed the clinical and radiological characteristics of patients with RICMs. The features of these RICMs were then compared with features of nonradiation cavernous malformations (CMs) in 270 patients. RESULTS Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0-19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118). CONCLUSIONS In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage.
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Feigin VL, Wiebers DO. Environmental factors and stroke: A selective review. J Stroke Cerebrovasc Dis 2012; 6:108-13. [PMID: 17894980 DOI: 10.1016/s1052-3057(97)80225-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/1996] [Accepted: 10/10/1996] [Indexed: 10/24/2022] Open
Abstract
Despite numerous prior stroke risk factor investigations, much remains unknown about the effect of environmental factor changes on stroke incidence and mortality rates. Yet these data might be important for defining a number of measures to prevent stroke and for developing a greater understanding of the origin and incidence trends of stroke in different regions and populations. In this paper we review the current state of knowledge about certain environmental stroke risk factors.
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Affiliation(s)
- V L Feigin
- From the University Department of Neurology, Utrecht, the Netherlands
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8
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Wong ET, Huberman M, Lu XQ, Mahadevan A. Bevacizumab reverses cerebral radiation necrosis. J Clin Oncol 2008; 26:5649-50. [PMID: 18981459 DOI: 10.1200/jco.2008.19.1866] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Eric T Wong
- Brain Tumor Center & Neuro-Oncology Unit, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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9
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Altered consciousness associated with brain neoplasms. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18631828 DOI: 10.1016/s0072-9752(07)01715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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10
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Martinez Del Pero M, Majumdar S, Coley SC, Parker AJ. Near fatal haemorrhage 35 years after radiation for laryngeal cancer: emergency embolisation of a vertebral artery aneurysm. Emerg Med J 2006; 23:e26. [PMID: 16549558 PMCID: PMC2579529 DOI: 10.1136/emj.2005.027896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The authors report a rare case of a 75 year old man who presented 35 years after radiotherapy for carcinoma of the larynx, with catastrophic bleeding through the mouth. Both the time and mode of presentation were unusual. The patient required emergency sacrifice of the left vertebral artery to stop the bleeding. The literature has been reviewed.
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Affiliation(s)
- M Martinez Del Pero
- Department of Ear, Nose and Throat, Royal Hallamshire Hospital, Sheffield, UK.
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11
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Lee JKL, Chelvarajah R, King A, David KM. Rare Presentations of Delayed Radiation Injury: A Lobar Hematoma and a Cystic Space-occupying Lesion Appearing More Than 15 Years after Cranial Radiotherapy: Report of Two Cases. Neurosurgery 2004; 54:1010-3; discussion 1013-4. [PMID: 15046671 DOI: 10.1227/01.neu.0000114868.82478.62] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Accepted: 10/07/2003] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE
Radiation vasculopathy and radionecrosis, constituting delayed radiation injury, are rare but recognized complications of radiation therapy occurring at a peak incidence of 3 years after treatment. Little information is available about these complications occurring more than 15 years after radiotherapy and presenting as other than solid intracranial masses.
CLINICAL PRESENTATION
We describe two patients who presented with space-occupying cerebral lesions. Patient 1 presented as an emergency with a sudden loss of consciousness. Computed tomography revealed a large left intracerebral hemorrhage; cerebral angiography disclosed nothing abnormal, and a primary spontaneous hemorrhage was presumed. Twenty-seven years earlier, this patient had received adjuvant whole-brain and spine radiotherapy and concomitant chemotherapy after excision of a vermis medulloblastoma. Patient 2 presented with a left frontal cystic lesion (presumed malignant glioma) as the cause of personality and behavioral changes for some months. She had previously received external beam radiation for a basal cell epithelioma, which had been excised from her left forehead 19 years earlier.
INTERVENTION
Both patients recovered well after undergoing craniotomies and removal of their lesions; they were discharged home with no neurological deficit.
CONCLUSION
Even after long intervals after radiotherapy, it is important to consider radiation vasculopathy and radionecrosis as differential diagnoses of more common conditions. Histological confirmation of a delayed radiation injury in the absence of any evidence of neoplasia or vascular abnormality has allowed appropriate prognosis and management to be formulated with confidence in each of these patients.
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Affiliation(s)
- Joshua K L Lee
- Department of Neurosurgery, Essex Centre for Neurological Sciences, Oldchurch Hospital, London, England, UK
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12
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Hillemanns A, Kortmann RD, Herrlinger U, Skalej M, Krapf H. Recurrent delayed brain hemorrhage over years after irradiation and chemotherapy for astrocytoma. Eur Radiol 2003; 13:1891-4. [PMID: 12942289 DOI: 10.1007/s00330-002-1635-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2002] [Revised: 06/27/2002] [Accepted: 07/10/2002] [Indexed: 11/24/2022]
Abstract
We report on an adult patient with a right frontal astrocytoma, classification WHO II, who suffered from radionecrosis 3.5 years after surgery and combined radio- and chemotherapy. Beginning 8 years after initial diagnosis, repeated episodes of bilateral cerebral hemorrhage and cavitation occurred. This case description emphasizes the possibility of repeated hemorrhage as a delayed reaction to brain irradiation and chemotherapy.
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Affiliation(s)
- Andreas Hillemanns
- Department of Neuroradiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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14
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Cheng KM, Chan CM, Fu YT, Ho LC, Cheung FC, Law CK. Acute hemorrhage in late radiation necrosis of the temporal lobe: report of five cases and review of the literature. J Neurooncol 2001; 51:143-50. [PMID: 11386411 DOI: 10.1023/a:1010631112015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hemorrhage in late cerebral radiation necrosis is a rare complication after radiotherapy for intracranial and extracranial neoplasms. We report 5 cases of acute hemorrhage in late radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma. In a review of the literature, the authors identified a total of 27 such cases. The interval period between the onset of hemorrhage and cranial irradiation is long (mean = 7.8 years). The most prominent histological feature was the proliferation of large, dilated and thin-walled new blood vessels in a background of gliosis and fibrinoid necrosis of vessels. Rupture of these thin-walled new blood vessels is the proposed mechanism of hemorrhage in this condition.
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Affiliation(s)
- K M Cheng
- Department of Neurosurgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
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15
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Koot RW, Troost D, Dingemans KP, van den Bergh Weerman MA, Bosch DA. Temporal lobe destruction with microvascular dissections following irradiation for rhinopharyngeal carcinoma. Neuropathol Appl Neurobiol 2000; 26:473-7. [PMID: 11054188 DOI: 10.1046/j.1365-2990.2000.00266.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chan YL, Leung SF, King AD, Choi PH, Metreweli C. Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging. Radiology 1999; 213:800-7. [PMID: 10580956 DOI: 10.1148/radiology.213.3.r99dc07800] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the morphologic characteristics of late radiation injury to the temporal lobes of the brain on magnetic resonance (MR) images. MATERIALS AND METHODS This was a prospective study involving 34 patients (age range, 37-72 years) with known radiation injury to the temporal lobes from radiation therapy administered 2-10 years previously for nasopharyngeal carcinoma MR imaging was performed with T2-weighted gradient- and spin-echo, gradient-recalled echo, T1-weighted spin-echo, fluid-attenuated inversion-recovery, and T1-weighted postcontrast spin-echo sequences. RESULTS Radiation injury was present in 57 of the 68 temporal lobes. The white matter lesions in radiation-induced injury were predominantly hyperintense on T2-weighted images, but in 37 (65%) of the 57 lobes, foci with heterogeneous signal intensity consistent with necrosis were detected. In the 57 involved lobes, gray matter lesions were detected in 50 (88%); blood-brain barrier disruption based on parenchymal contrast enhancement, in 51 (89%); and hemosiderin deposits, in 30 (53%). There was a significant correlation between white matter necrosis, gray matter lesions, and blood-brain barrier disruption, all of which were located mainly in the inferior temporal lobes that received the highest radiation dose. CONCLUSION The lesion components of radiation-induced injury to the temporal lobes at MR imaging were more varied than have been previously described. In addition to the classic white matter lesions, gray matter lesions, blood-brain barrier disruption, and hemosiderin deposition also were frequently seen.
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Affiliation(s)
- Y L Chan
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, People's Republic of China.
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17
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Abstract
Neurocognitive dysfunction is a common sequela of cranial irradiation that is especially severe in young children. The underlying mechanisms of this disorder have not been described. The present review describes the role of the hippocampus and the anatomically related cortex in memory function and its marked susceptibility to ischemic and hypoxic injury. Based on studies of animal models of human amnesia and histopathological findings in the irradiated brain, the neurocognitive sequela of cranial irradiation can be seen to be mediated through vascular injury, resulting in ischemia and hypoxia in the hippocampal region. Recognition of the site and mechanisms of this injury may lead to the development of techniques to minimize the risks.
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Affiliation(s)
- O K Abayomi
- Department of Radiation Oncology, Howard University Hospital, Washington, D.C., USA
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18
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Chung E, Bodensteiner J, Hogg JP. Spontaneous intracerebral hemorrhage: a very late delayed effect of radiation therapy. J Child Neurol 1992; 7:259-63. [PMID: 1634747 DOI: 10.1177/088307389200700304] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cerebral necrosis is a well-known delayed sequela of radiation to the central nervous system. Delayed intracerebral hemorrhage occurring several years after radiation is rare; however, with increased survival, this complication will become more common. We report a child who developed a brain-stem hemorrhage 4.5 years following radiation therapy for brainstem tumor. The possible pathogenesis for the spontaneous hemorrhage is discussed. The onset of the neurologic symptoms in this setting occurs later than the usual symptoms of radiation necrosis. It is important to recognize this entity as a late delayed complication of radiation therapy and not to mistake it for tumor recurrence.
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Affiliation(s)
- E Chung
- Department of Neurology and Pediatrics, West Virginia University Health Sciences Center, Morgantown
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Bederson JB, Harsh GR, Walker JA, Wilson CB. Radiation-induced bilateral cystic temporal lobe necrosis: reversal of memory deficit after fenestration and internal shunting. Case report. J Neurosurg 1990; 72:503-5. [PMID: 2303885 DOI: 10.3171/jns.1990.72.3.0503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors report a case in which bilateral cystic temporal lobe necrosis developed after treatment of nasopharyngeal lymphoepithelioma with 7000 cGy of external beam radiation. The patient presented with an isolated memory deficit that was documented by neuropsychological testing. After fenestration and internal shunting of both cysts, there was striking resolution of the lesions and of the memory deficit.
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Affiliation(s)
- J B Bederson
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco
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Woo E, Lam K, Yu YL, Ma J, Wang C, Yeung RT. Temporal lobe and hypothalamic-pituitary dysfunctions after radiotherapy for nasopharyngeal carcinoma: a distinct clinical syndrome. J Neurol Neurosurg Psychiatry 1988; 51:1302-7. [PMID: 3225587 PMCID: PMC1032919 DOI: 10.1136/jnnp.51.10.1302] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Eleven patients with combined neurological and endocrine complications after external radiotherapy for nasopharyngeal carcinoma are described. Neurologically, memory disturbance, complex partial seizures and hypodense areas in one or both temporal lobes on CT were typical features. Endocrinologically, hypopituitarism was the prominent manifestation. This constellation of clinical features in a patient with previous radiotherapy to the nasopharynx characterises radiation injury to the inferomedial aspects of the temporal lobes and the hypothalamic-pituitary axis. While the parenchymal brain lesions may mimic metastases or glioma on CT, the associated endocrine disturbance would betray the correct diagnosis. The importance of recognising the hypopituitarism which may be clinically asymptomatic and which is amenable to therapy is emphasised, as is the need for a proper fractionation of the radiation dose to minimise the incidence of these disabling complications.
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Affiliation(s)
- E Woo
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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