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Progressive Deterioration of Intellect and Motor Function Occurring Several Decades After Cranial Irradiation: A New Facet in the Clinical Spectrum of Radiation Encephalopathy

Progressive Deterioration of Intellect and Motor Function Occurring Several Decades After Cranial... Abstract Objective: To report the cases of 2 patients who developed the features of radiation encephalopathy 33 and 28 years after cranial irradiation. Design: Case reports; clinical data were available for 2 years in each instance. Conclusion: Latent intervals approaching 2 decades have been reported in cases of radiation necrosis following cranial irradiation, but a similar or greater delay before the onset of radiation encephalopathy has not been described previously. This report indicates that a diagnosis of radiation encephalopathy must be considered when any individual who has received cranial irradiation presents with deterioration in intellectual or motor function, whatever the interval. References 1. References 8, 9, 12, 13, 16-18, 22, 23, 30, 31. 2. Boden G. Radiation myelitis of the brain stem . J Fac Radiol . 1950;2:79-94.Crossref 3. Okeda R, Shibata T. Radiation encephalopathy: an autopsy case and some comments on the pathogenesis of delayed radionecrosis of the central nervous system . Acta Pathol Jpn . 1973;23:867-883. 4. Ballantyne AJ. Late sequelae of radiation therapy in cancer of the head and neck with particular reference to the nasopharynx . Am J Surg . 1975;130:433-466.Crossref 5. Larkins RG, Martin FIR. Hypopituitarism after extracranial irradiation: evidence for hypothalamic origin . BMJ . 1973;1:152.Crossref 6. Al-Mefty O, Kersh JE, Routh A, Smith RR. The long term side effects of radiation therapy for benign brain tumors in adults . J Neurosurg . 1990;73:502-512.Crossref 7. Tomita T. Long-term effects of treatment for childhood brain tumors . Neurosurg Clin North Am . 1992;3:959-971. 8. Goepfert H, Jesse RH, Lindberg RD. Arterial infusion and radiation therapy in the treatment of advanced cancer of the nasal cavity and paranasal sinuses . Am J Surg . 1973;126:464-468.Crossref 9. Martins AN, Johnston JS, Henry JM, Stoffel TJ, Di Chiro G. Delayed radiation necrosis of the brain . J Neurosurg . 1977;47:336-345.Crossref 10. Dropcho EJ. Central nervous system injury by therapeutic irradiation . Neurol Clin . 1991;9:969-988. 11. Kramer S. The hazards of therapeutic irradiation of the central nervous system . Clin Neurosurg . 1968;15:301-318. 12. Duffner PK, Cohen ME. The long-term effects of central nervous system therapy on children with brain tumors . Neurol Clin . 1991;9:479-495. 13. Pennybacker J, Russel DS. Necrosis of the brain due to radiation therapy . J Neurol Neurosurg Psychiatry . 1948;11:183-198.Crossref 14. Chandler A, Tucker FC, Herzberger EE. Late radiation necrosis of the brain . Wis Med J . 1964;63:297-300. 15. Marra A, Giuffre R. Late cerebral radionecrosis . Eur Neurol . 1968;1:234-246.Crossref 16. Kramer S, Lee KF. Complications of radiation therapy: the central nervous system . Semin Roentgenol . 1974;9:75-83.Crossref 17. Eyster EF, Nielsen SL, Sheline GE, Wilson GB. Cerebral radiation necrosis simulating a brain tumor . J Neurosurg . 1974;39:267-271.Crossref 18. Diengdoh JV, Booth AE. Postirradiation necrosis of the temporal lobe presenting as a glioma . J Neurosurg . 1976;44:732-734.Crossref 19. Kusske JA, Williams P, Garcia JH, Pribram HW. Radiation necrosis of the brain following radiotherapy of extracerebral neoplasms . Surg Neurol . 1976;6:15-20. 20. Queiroz LDS, Da Cruz Neto JN. Late pseudotumoral brain necrosis following irradiation of a scalp neoplasm . J Neurosurg . 1976;45:581-584.Crossref 21. Takeuchi J, Hanakita J, Abe M, Handa H. Brain necrosis after repeated radiotherapy . Surg Neurol . 1976;5:89-93. 22. Rottenberg DA, Chernik NL, Deck MDF, Ellis F, Posner JB. Cerebral necrosis following radiotherapy of extracranial neoplasms . Ann Neurol . 1977;1:339-357.Crossref 23. Littman P, James H, Zimmerman R, Slater R. Radionecrosis of the brain presenting as a mass lesion: a case report . J Neurol Neurosurg Psychiatry . 1977; 40:827-829.Crossref 24. Matsumura H, Ross ER. Delayed cerebral radionecrosis following treatment of carcinoma of the scalp: clinicopathologic and ultrastructural study . Surg Neurol . 1979;12:193-204. 25. Sterman A, Protass LM. An atypical case of delayed radiation necrosis of the brain . Arch Neurol . 1979;36:655-656.Crossref 26. Pardo-Mindan FJ, Delgado G, Ezcurdia J, Quintanilla E. Delayed cerebral radionecrosis following treatment of basal cell carcinoma . Arch Neurol . 1979; 36:382-383.Crossref 27. Julow J, Slowik F, Kelemen J, Goracz I. Late post irradiation necrosis of the brain . Acta Neurochir Wien . 1979;46:135-150.Crossref 28. Sharma U, Tandon PN, Rath GK, et al. Delayed brain necrosis in irradiated adenoid cystic carcinoma of nose: a case report . Indian J Cancer . 1980;17:59-63. 29. Sheline GE, Wara WM, Smith V. Therapeutic irradiation and brain injury . Int J Radiat Oncol Biol Phys . 1980;6:336-345.Crossref 30. Kingsley DPE, Kendell BE. CT of the adverse effects of therapeutic radiation of the central nervous system . Am J Neuroradiol . 1981;2:453-460. 31. Shaw PJ, Bates D. Conservative treatment of delayed cerebral radiation necrosis . J Neurol Neurosurg Psychiatry . 1984;47:1338-1341.Crossref 32. Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation induced encephalopathy . J Clin Oncol . 1994;12:627-642. 33. Hochberg FH, Slotnick B. Neuropsychologic impairment in astrocytoma survivors . Neurology . 1980;30:172-177.Crossref 34. So NK, O'Neill BP, Frytak S, Eagan RT, Earnest F, Lee RE. Delayed leukoencephalopathy in survivors with small cell lung cancer . Neurology . 1987;37:1198-1201.Crossref 35. Asai A, Matsutani M, Kohno T, et al. Subacute brain atrophy after radiation therapy for malignant brain tumor . Cancer . 1989;63:1962-1974.Crossref 36. Frytak S, Shaw JN, O'Neill BP, et al. Leukoencephalopathy in small cell lung cancer patients receiving prophylactic cranial irradiation . Am J Clin Oncol . 1989; 12:27-33.Crossref 37. DeAngelis LM, Delattre J, Posner JB. Radiation induced dementia in patients cured of brain metastases . Neurology . 1989;39:789-796.Crossref 38. Lishner M, Feld R, Payne DG, et al. Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience . J Clin Oncol . 1990;8:215-221. 39. Imperato JP, Paleologos NA, Vick NA. Effects of treatment on long-term survivors with malignant astrocytomas . Ann Neurol . 1990;28:818-822.Crossref 40. Fernandez-Bouzas A, Jimenez HR, Zamudio JV, Alonso-Vanegas M, Guerra MR. Brain cacifications and dementia in children treated with radiotherapy and intrathecal methotrexate . J Neurosurg Sci . 1992;36:211-214. 41. Naheedy MH, O'Reilly GV, Rumbaugh CL, Hammerschlag SB. Computed tomography of the brain following radiation and chemotherapy: preliminary report . Comput Radiol . 1982;6:199-204.Crossref 42. Curnes JT, Laster DW, Ball MR, Moody DM, Witcofski RL. Magnetic resonance imaging of radiation injury to the brain . Am J Neuroradiol . 1986;7:389-394. 43. Price RA, Jamieson PA. The central nervous system in childhood leukemia, II: subacute leukoencephalopathy . Cancer . 1975;35:306-318.Crossref 44. Russel DS, Wilson CW, Tansley K. Experimental radionecrosis of the brain in rabbits . J Neurol Neurosurg . 1949;12:187-195.Crossref 45. Rottenberg DA, Horten B, Kim JH, Posner JB. Progressive white matter destruction following irradiation of an extracranial neoplasm . Ann Neurol . 1980; 8:76-78.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Progressive Deterioration of Intellect and Motor Function Occurring Several Decades After Cranial Irradiation: A New Facet in the Clinical Spectrum of Radiation Encephalopathy

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1996.00550080140022
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See Article on Publisher Site

Abstract

Abstract Objective: To report the cases of 2 patients who developed the features of radiation encephalopathy 33 and 28 years after cranial irradiation. Design: Case reports; clinical data were available for 2 years in each instance. Conclusion: Latent intervals approaching 2 decades have been reported in cases of radiation necrosis following cranial irradiation, but a similar or greater delay before the onset of radiation encephalopathy has not been described previously. This report indicates that a diagnosis of radiation encephalopathy must be considered when any individual who has received cranial irradiation presents with deterioration in intellectual or motor function, whatever the interval. References 1. References 8, 9, 12, 13, 16-18, 22, 23, 30, 31. 2. Boden G. Radiation myelitis of the brain stem . J Fac Radiol . 1950;2:79-94.Crossref 3. Okeda R, Shibata T. Radiation encephalopathy: an autopsy case and some comments on the pathogenesis of delayed radionecrosis of the central nervous system . Acta Pathol Jpn . 1973;23:867-883. 4. Ballantyne AJ. Late sequelae of radiation therapy in cancer of the head and neck with particular reference to the nasopharynx . Am J Surg . 1975;130:433-466.Crossref 5. Larkins RG, Martin FIR. Hypopituitarism after extracranial irradiation: evidence for hypothalamic origin . BMJ . 1973;1:152.Crossref 6. Al-Mefty O, Kersh JE, Routh A, Smith RR. The long term side effects of radiation therapy for benign brain tumors in adults . J Neurosurg . 1990;73:502-512.Crossref 7. Tomita T. Long-term effects of treatment for childhood brain tumors . Neurosurg Clin North Am . 1992;3:959-971. 8. Goepfert H, Jesse RH, Lindberg RD. Arterial infusion and radiation therapy in the treatment of advanced cancer of the nasal cavity and paranasal sinuses . Am J Surg . 1973;126:464-468.Crossref 9. Martins AN, Johnston JS, Henry JM, Stoffel TJ, Di Chiro G. Delayed radiation necrosis of the brain . J Neurosurg . 1977;47:336-345.Crossref 10. Dropcho EJ. Central nervous system injury by therapeutic irradiation . Neurol Clin . 1991;9:969-988. 11. Kramer S. The hazards of therapeutic irradiation of the central nervous system . Clin Neurosurg . 1968;15:301-318. 12. Duffner PK, Cohen ME. The long-term effects of central nervous system therapy on children with brain tumors . Neurol Clin . 1991;9:479-495. 13. Pennybacker J, Russel DS. Necrosis of the brain due to radiation therapy . J Neurol Neurosurg Psychiatry . 1948;11:183-198.Crossref 14. Chandler A, Tucker FC, Herzberger EE. Late radiation necrosis of the brain . Wis Med J . 1964;63:297-300. 15. Marra A, Giuffre R. Late cerebral radionecrosis . Eur Neurol . 1968;1:234-246.Crossref 16. Kramer S, Lee KF. Complications of radiation therapy: the central nervous system . Semin Roentgenol . 1974;9:75-83.Crossref 17. Eyster EF, Nielsen SL, Sheline GE, Wilson GB. Cerebral radiation necrosis simulating a brain tumor . J Neurosurg . 1974;39:267-271.Crossref 18. Diengdoh JV, Booth AE. Postirradiation necrosis of the temporal lobe presenting as a glioma . J Neurosurg . 1976;44:732-734.Crossref 19. Kusske JA, Williams P, Garcia JH, Pribram HW. Radiation necrosis of the brain following radiotherapy of extracerebral neoplasms . Surg Neurol . 1976;6:15-20. 20. Queiroz LDS, Da Cruz Neto JN. Late pseudotumoral brain necrosis following irradiation of a scalp neoplasm . J Neurosurg . 1976;45:581-584.Crossref 21. Takeuchi J, Hanakita J, Abe M, Handa H. Brain necrosis after repeated radiotherapy . Surg Neurol . 1976;5:89-93. 22. Rottenberg DA, Chernik NL, Deck MDF, Ellis F, Posner JB. Cerebral necrosis following radiotherapy of extracranial neoplasms . Ann Neurol . 1977;1:339-357.Crossref 23. Littman P, James H, Zimmerman R, Slater R. Radionecrosis of the brain presenting as a mass lesion: a case report . J Neurol Neurosurg Psychiatry . 1977; 40:827-829.Crossref 24. Matsumura H, Ross ER. Delayed cerebral radionecrosis following treatment of carcinoma of the scalp: clinicopathologic and ultrastructural study . Surg Neurol . 1979;12:193-204. 25. Sterman A, Protass LM. An atypical case of delayed radiation necrosis of the brain . Arch Neurol . 1979;36:655-656.Crossref 26. Pardo-Mindan FJ, Delgado G, Ezcurdia J, Quintanilla E. Delayed cerebral radionecrosis following treatment of basal cell carcinoma . Arch Neurol . 1979; 36:382-383.Crossref 27. Julow J, Slowik F, Kelemen J, Goracz I. Late post irradiation necrosis of the brain . Acta Neurochir Wien . 1979;46:135-150.Crossref 28. Sharma U, Tandon PN, Rath GK, et al. Delayed brain necrosis in irradiated adenoid cystic carcinoma of nose: a case report . Indian J Cancer . 1980;17:59-63. 29. Sheline GE, Wara WM, Smith V. Therapeutic irradiation and brain injury . Int J Radiat Oncol Biol Phys . 1980;6:336-345.Crossref 30. Kingsley DPE, Kendell BE. CT of the adverse effects of therapeutic radiation of the central nervous system . Am J Neuroradiol . 1981;2:453-460. 31. Shaw PJ, Bates D. Conservative treatment of delayed cerebral radiation necrosis . J Neurol Neurosurg Psychiatry . 1984;47:1338-1341.Crossref 32. Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation induced encephalopathy . J Clin Oncol . 1994;12:627-642. 33. Hochberg FH, Slotnick B. Neuropsychologic impairment in astrocytoma survivors . Neurology . 1980;30:172-177.Crossref 34. So NK, O'Neill BP, Frytak S, Eagan RT, Earnest F, Lee RE. Delayed leukoencephalopathy in survivors with small cell lung cancer . Neurology . 1987;37:1198-1201.Crossref 35. Asai A, Matsutani M, Kohno T, et al. Subacute brain atrophy after radiation therapy for malignant brain tumor . Cancer . 1989;63:1962-1974.Crossref 36. Frytak S, Shaw JN, O'Neill BP, et al. Leukoencephalopathy in small cell lung cancer patients receiving prophylactic cranial irradiation . Am J Clin Oncol . 1989; 12:27-33.Crossref 37. DeAngelis LM, Delattre J, Posner JB. Radiation induced dementia in patients cured of brain metastases . Neurology . 1989;39:789-796.Crossref 38. Lishner M, Feld R, Payne DG, et al. Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience . J Clin Oncol . 1990;8:215-221. 39. Imperato JP, Paleologos NA, Vick NA. Effects of treatment on long-term survivors with malignant astrocytomas . Ann Neurol . 1990;28:818-822.Crossref 40. Fernandez-Bouzas A, Jimenez HR, Zamudio JV, Alonso-Vanegas M, Guerra MR. Brain cacifications and dementia in children treated with radiotherapy and intrathecal methotrexate . J Neurosurg Sci . 1992;36:211-214. 41. Naheedy MH, O'Reilly GV, Rumbaugh CL, Hammerschlag SB. Computed tomography of the brain following radiation and chemotherapy: preliminary report . Comput Radiol . 1982;6:199-204.Crossref 42. Curnes JT, Laster DW, Ball MR, Moody DM, Witcofski RL. Magnetic resonance imaging of radiation injury to the brain . Am J Neuroradiol . 1986;7:389-394. 43. Price RA, Jamieson PA. The central nervous system in childhood leukemia, II: subacute leukoencephalopathy . Cancer . 1975;35:306-318.Crossref 44. Russel DS, Wilson CW, Tansley K. Experimental radionecrosis of the brain in rabbits . J Neurol Neurosurg . 1949;12:187-195.Crossref 45. Rottenberg DA, Horten B, Kim JH, Posner JB. Progressive white matter destruction following irradiation of an extracranial neoplasm . Ann Neurol . 1980; 8:76-78.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Aug 1, 1996

References