title: Delayed diagnosis of probable radiation induced spinal cord vascular disorders.
abstract: Occasionally, unexpected neurological deficits occur after lumbar spinal surgery. We report a case of monoparesis after lumbar decompressive surgery. A 63-year-old man, who had undergone decompression of L4-5 for spinal stenosis 4 days previously in the other hospital, visted the emergency department with progressive weakness in the left leg and hypoesthesia below sensory level T7 on the right side. He had been cured of lung cancer with chemotherapy and radiation therapy 10 years previously, but detailed information of radiotherapy was not available. Whole spine magnetic resonance (MR) imaging showed fatty marrow change from T1 to T8, most likely due to previous irradiation. The T2-weighted MR image showed a high-signal T4-5 spinal cord lesion surrounded by a low signal rim, and the T1-weighted MR image showed focal high signal intensity with focal enhancement. The radiological diagnosis was vascular disorders with suspicious bleeding. Surgical removal was refused by the patient. With rehabilitation, the patient could walk independently without assistance 2 months later. Considering radiation induced change at thoracic vertebrae, vascular disorders may be induced by irradiation. If the spinal cord was previously irradiated, radiation induced vascular disorders needs to be considered.
authors: Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. ; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors: Young Il
authors: YI
authors: Won
authors: Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. ; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors: Chi Heon
authors: CH
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. ; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. ; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.
authors: Chun Kee
authors: CK
authors: Chung
authors: Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors: Tae Jin
authors: TJ
authors: Yun
keywords: Cavernous malformation; Radiation therapy; Spinal cord; Vascular disorders