Medullary hemorrhagic infarction after radiation for nasopharyngeal carcinoma.
Head and neck irradiation may lead to accelerated atherosclerosis over several years. Delayed stroke has been described after head and neck irradiation administered for a number of conditions. However, brain stem stroke has only rarely been associated with irradiation. We report a patient with medullary hemorrhagic infarction 6 years after radiotherapy for nasopharyngeal carcinoma. A 42-year-old normotensive Chinese male had rapid onset of vertigo, diplopia, ataxia, dysphagia, hypophonic dysarthria, hemiparesis, and respiratory distress. Cranial MR imaging 2 days after symptom onset showed medullary infarction, and cranial MR imaging 5 days after symptom onset showed medullary hemorrhage. He needed ventilatory support and died of bacterial pneumonia 1 month later. Other risk factors for stroke were absent. Hemorrhagic infarction in this patient was likely associated with the radiotherapy. Radiotherapy is the first choice of treatment for nasopharyngeal carcinoma, however, it may induce fatal medullary hemorrhagic infarction.
Liu
Jian-Ren
JR
Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, China.
Huang
Jian
J
Zhang
Min
M
Wei
Qi-Chun
QC
Song
Ying
Y
Huang
Jian-Zheng
JZ
Ding
Mei-Ping
MP
Jia
Ping-Juan
PJ
D000328:Adult; D044466:Asian People; D002277:Carcinoma / Q000208:ethnology / Q000532:radiotherapy*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D009303:Nasopharyngeal Neoplasms / Q000208:ethnology / Q000532:radiotherapy*; D018410:Pneumonia, Bacterial / Q000150:complications; D011832:Radiation Injuries / Q000150:complications*