title: [Subacute leukoencephalopathy of the rhombencephalon after pituitary radiotherapy].
abstract: Two patients had early delayed leucoencephalopathy mainly confined to the brainstem after radiotherapy for pituitary tumours. To our knowledge, we report the first MRI description. The patients had somatotroph cell adenomas (associated with prolactin secretion, patient 2). Surgical removal of the adenomas were complete (patient 1) and partial (patient 2). Both underwent pituitary irradiation: patient 1, 55.8 Gy (31 x 1.8 Gy); patient 2, 54 Gy (27 x 2 Gy). Six weeks after completion of radiation, the patients had low vigilance, sleepiness, cerebellar symptoms, optic neuropathy (patient 1), CSF inflammatory reaction. T2-weighted MRI scans showed hypersignal in brainstem, cerebellar peduncles (both patients), temporal lobe white matter (patient 2). T1-weighted images showed hyposignals, pseudonecrotic and contrast-enhanced images in brainstem (patient 1). Both patients responded to intravenous then oral steroid treatment with a progressive and complete clinical recovery. Radiological abnormalities improved with clinical statement. Present characteristics support a demyelinating mechanism of early delayed cerebral radiation injuries.
authors.affiliation: Clinique de Neurologie, Hôpital du Val-de-Grâce, Paris.
authors.forename: A
authors.initials: A
authors.lastname: Créange
authors.forename: D
authors.initials: D
authors.lastname: Felten
authors.forename: I
authors.initials: I
authors.lastname: Kiesel
authors.forename: J L
authors.initials: JL
authors.lastname: Renard
authors.forename: H
authors.initials: H
authors.lastname: Vespignani
authors.forename: D
authors.initials: D
authors.lastname: Béquet
mesh_terms: D000236:Adenoma / Q000532:radiotherapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002524:Cerebellar Ataxia / Q000209:etiology; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010910:Pituitary Irradiation / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000532:radiotherapy; D012249:Rhombencephalon
chemical_list: D000305:Adrenal Cortex Hormones; D013006:Growth Hormone
vernacular_title: Leucoencéphalopathie subaiguë du rhombencéphale après radiothérapie hypophysaire.