RADIATIONINDUCED CENTRAL DEMYELINATING LEUKOENCEPHALOPATHY

Abstract

Background. Great improvement in survival has resulted from the contemporary treatment of cancer.However, this has been associated with the appearance of various previously unobserved neurological complications that have recently been reviewed.That radiotherapy is responsible is suggested by many features.Leukoencephalopathy appears after a quite regular delay following irradiation.They electively involve the endothelial cells with a break down of the blood-brain barrier, fibrinoid necrosis, perivascular exudation and mononuclear infiltration leading to foci of myelin destruction of different ages. Case. A 63 year old male patient was diagnosed with metastatic small cell lung cancer 20 months ago, and cisplatin+vepesid chemotherapy is started.At the 6th month of the treatment, prophylactic intracranial radiotherapy is given 3 times with an interval of 2 months. After the treatment,he had oversleeping,sluggishness, and epileptic seizures.Diffuse T2 hyperintensities were observed in the Cranial MRG taken.There was no pathology to explain the situation in the blood tests of the patient with diffuse slowing in his EEG.The patient was started on antiepileptic and steroid treatment and was followed up. Conclusion. Clinically there is progressive psychomotor deterioration.Convulsions are very rare and were seen in our patient.The MRG pattern was also very characteristic in our case especially affecting the white matter.In our case,the striking white matter predominance of the lesions was clearly shown in the pons where circumscribed areas of demyelination affected the ponto-cerebellar fibres whereas the neurons of the pontine nuclei were spared.That radiotherapy is responsible is suggested by many features.As in the cases of De Vivo et al,Rosemberg and Bleyer and Griffin,leukoencephalopathy appears after a quite regular delay following irradiation.The lesions are limited to the irradiated brain and spare the unirradiated spinal cord.The frequency of leukoencephalopathy increases with increasing doses of irradiation.This case suggests Demyelinating Leukoencephalopathy with clinical and radiological findings, biopsy is required for definitive diagnosis.