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Subacute brain atrophy after radiation therapy for malignant brain tumor
Author(s) -
Asai Akio,
Matsutani Masao,
Kohno Takeshi,
Nakamura Osamu,
Tanaka Hideki,
Fujimaki Takamitsu,
Funada Nobuaki,
Matsuda Tadayoshi,
Nagata Kazuya,
Takakura Kintomo
Publication year - 1989
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19890515)63:10<1962::aid-cncr2820631016>3.0.co;2-v
Subject(s) - medicine , white matter , pathology , lateral ventricles , atrophy , radiation therapy , basal ganglia , lumbar , autopsy , cerebral atrophy , hyperintensity , brain tumor , radiology , magnetic resonance imaging , central nervous system
Brain atrophy with mental and neurologic deterioration developing a few months after radiation therapy in patients without residual or recurrent brain tumors has been recognized. Two illustrative case reports of this pathologic entity are presented. Six autopsy cases with this entity including the two cases were reviewed neurologically, radiographically, and histopathologically. All patients presented progressive disturbances of mental status and consciousness, akinesia, and tremor‐like involuntary movement. Computerized tomography (CT) demonstrated marked enlargement of the ventricles, moderate widening of the cortical sulci, and a moderately attenuated CT number for the white matter in all six patients. Four of the six patients had CSF drainage (ventriculoperitoneal shunt or continuous lumbar drainage), however, none of them improved. Histologic examination demonstrated swelling and loss of the myelin sheath in the white matter in all patients, and reactive astrocytosis in three of the six patients. Neither prominent neuronal loss in the cerebral cortex or basal ganglia, nor axonal loss in the white matter was generally identified. The blood vessels of the cerebral cortex and white matter were normal. Ependymal layer and the surrounding brain tissue were normal in all patients. These findings suggested that this pathologic condition results from demyelination secondary to direct neurotoxic effect of irradiation. The authors' previous report was reviewed and the differential diagnoses, the risk factors for this pathologic entity, and the indication for radiation therapy in aged patients with a malignant brain tumor are discussed.