Silent lacunar lesions detected by magnetic resonance imaging of children with brain tumors: a late sequela of therapy.
BACKGROUND
Cerebral lacunes, which generally appear on magnetic resonance imaging as foci of white matter loss, usually occur in adults after ischemic infarcts. We report the development of lacunes in children after therapy for brain tumors.


METHODS
We reviewed the clinical characteristics and radiologic studies of 524 consecutive children with brain tumors treated over a 10-year period. We documented the neuropsychologic findings associated with lacunes and the factors predictive of lacunar development.


RESULTS
Lacunes developed in none of the 103 patients observed or treated with surgery alone. Twenty-five of the 421 patients treated with chemotherapy or radiation therapy or both had lacunes. Patients were a median of 4.5 years old at the time of both diagnosis (range, 0.3 to 19.8 years) and radiotherapy (range, 1.5 to 20 years). Fourteen patients were treated with craniospinal irradiation, and 11 were treated with local radiotherapy. The median time from radiotherapy to the appearance of lacunes was 2.01 years (range, 0.26 to 5.7 years). For all patients, lacunes were an incidental finding with no corresponding clinical deficits. The factor most predictive of lacunar development was age less than 5 years at the time of radiotherapy (P =.010). There was no significant difference in estimated decline in intelligence quotient scores between patients with lacunes and age and diagnosis-matched controls.


CONCLUSIONS
Lacunes may be caused by therapy-induced vasculopathy in children with brain tumors, with the most significant predictor being age less than 5 years at the time of radiotherapy.
Fouladi
M
M
St Jude Children's Research Hospital/Le Bonheur Children's Medical Center Brain Tumor Team, Memphis, TN, USA.
Langston
J
J
Mulhern
R
R
Jones
D
D
Xiong
X
X
Yang
J
J
Thompson
S
S
Walter
A
A
Heideman
R
R
Kun
L
L
Gajjar
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007223:Infant; D007360:Intelligence; D008279:Magnetic Resonance Imaging; D008297:Male; D009484:Neuropsychology; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013131:Spine / Q000528:radiation effects; D013223:Statistics as Topic; D013997:Time Factors