Pseudotumoral delayed cerebral radionecrosis
Creators
- 1. Centre Hospitalier de Bicetre, 94 - Le Kremlin-Bicetre (France)
Description
A 60 year-old woman with a scalp epithelioma underwent radiotherapy, the dose being 57 Gray. A first epileptic seizure occurred twenty months later. Neurological examination revealed signs of left hemisphere involvement. γEG, angiography, CT scans, demonstrated a pseudotumoral avascular process. On account of the localisation, the patient being right-handed, no surgical procedure was performed. In spite of corticotherapy and anticonvulsive treatment, seizures recurred and neurological signs slowly progressed. The patient died, 22 months after the first seizure, of an associated disseminated carcinoma with cachexia. Neuropathological examination showed a massive lesion presenting all the features of delayed radionecrosis in the left hemisphere: situated mainly in the white matter; numerous vascular abnormalities; wide-spread demyelination; disappearance of oligoglial cells. The Authors recall the clinical and anatomical aspects of this condition for which the only successful treatment is surgical removal when location and size of the lesion permit. Finally, the mechanisms which have been proposed to explain this delayed cerebral radionecrosis are discussed
Abstract (French)
Une malade de 60 ans presente un epithelioma du cuir chevelu pour lequel elle recoit une radiotherapie de 57 Gray. Vingt mois plus tard, survient une premiere crise comitiale et l'examen neurologique montre les signes d'une atteinte hemispherique gauche; les examens complementaires (scintigraphie, arteriographie, TDM) mettent en evidence un processus pseudo-tumoral avasculaire. Cette malade etant droitiere, aucune tentative chirurgicale n'est pratiquee. Malgre une corticotherapie et un traitement anticonvulsivant, les crises se repetent et les troubles neurologiques s'aggravent, bien que lentement. La malade decede 22 mois apres la premiere crise, non pas de son atteinte hemispherique, mais d'un second processus neoplasique, dissemine avec cachexie. A l'examen anatomique, on retrouve une atteinte massive d'une grande partie de l'hemisphere gauche ayant tous les caracteres d'une radionecrose retardee: predominance des lesions dans la substance blanche, importantes anomalies vasculaires, demyelinisation etendue, proliferation de la microglie et de la macroglie alors qu'il n'y a plus de cellules oligogliales. Les auteurs rappellent les caracteres cliniques et anatomiques de ces lesions post-radiques pour lesquelles le seul traitement qui puisse etre envisage est l'exerese chirurgicale lorsque le siege et les dimensions de la necrose la permettent; ils envisagent ensuite les principaux mecanismes qui ont ete proposes pour expliquer ces atteintesAdditional details
Additional titles
- Original title (French)
- Forme pseudo-tumorale de radionecrose retardee de l'encephale
Publishing Information
- Journal Title
- Ann. Med. Interne
- Journal Volume
- 136
- Journal Issue
- 2
- Series
- Ann. Med. Interne.
- Journal Page Range
- 137-141
- ISSN
- 0003-410X
INIS
- Country of Publication
- France
- Country of Input or Organization
- France
- INIS RN
- 16071004
- Subject category
- S63: RADIATION, THERMAL, AND OTHER ENVIRONMENTAL POLLUTANT EFFECTS ON LIVING ORGANISMS AND BIOLOGICAL MATERIALS;
- Descriptors DEI
- BRAIN; DELAYED RADIATION EFFECTS; NECROSIS; RADIOTHERAPY
- Descriptors DEC
- BIOLOGICAL EFFECTS; BIOLOGICAL RADIATION EFFECTS; BODY; CENTRAL NERVOUS SYSTEM; DISEASES; MEDICINE; NERVOUS SYSTEM; ORGANS; PATHOLOGICAL CHANGES; RADIATION EFFECTS; THERAPY