Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-23T00:28:36.986Z Has data issue: false hasContentIssue false

Fulminant Strokes Secondary to Radiation-induced Small-vessel Arteriopathy

Published online by Cambridge University Press:  02 May 2014

Charles D. Kassardjian*
University of Toronto, Toronto, Ontario, Canada
Ari Breiner
University of Toronto, Toronto, Ontario, Canada Toronto General Hospital, Toronto, Ontario, Canada
Martin del Campo
University of Toronto, Toronto, Ontario, Canada Toronto Western Hospital, Toronto, Ontario, Canada Krembil Neurosciences Centre, Totonto, Ontario, Canada
Address for correspondence: Charles D. Kassardjian, MD, 399 Bathurst St, Suite WW5-443, Toronto, Ontario, M5T 2S8, Canada. E-mail:
Get access


Delayed vasculopathy associated with prior brain irradiation is a known cause of stroke. Radiation is implicated in large-vessel stenosis, cavernous malformations and, rarely, small-vessel disease. There have been no reported cases of fulminant ischaemic and haemorrhagic strokes secondary to radiation vasculopathy. We present the case of a 40-year-old woman with a history of childhood leukaemia and whole-body and cranio-cervical radiation. The patient presented with recurrent acute neurological deficits over a 4-month period resulting from haemorrhagic and ischaemic strokes. Imaging revealed numerous cavernomas and small-vessel acute infarctions. No traditional stroke aetiology was identified. Delayed radiation-induced vasculopathy should be considered in patients with a history of brain irradiation and ischaemic or haemorrhagic strokes, and can present in a fulminant manner with recurrent strokes over a short period of time.

Clinical Practice: Current Opinion
Copyright © Australasian Society for the Study of Brain Impairment 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Kang, J.H., Kwon, S.U., & Kim, J.S. (2002). Radiation-induced angiopathy in acute stroke patients. Journal of Stroke and Cerebrovascular Diseases, 11 (6), 315319.Google Scholar
Keezer, M.R., & Del Maestro, R. (2009). Radiation-induced cavernous hemangiomas: case report and literature review. Canadian Journal of Neurological Sciences, 36 (3), 303310.Google Scholar
Plummer, C., Henderson, R.D., O’Sullivan, J.D., & Read, S.J. (2011). Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke, 42 (9), 24102418.Google Scholar
Salih, I.S., Higgins, N.J., Warburton, E.A., & Baron, J.C. (2007). Lacunar stroke attributable to radiation-induced intracranial arteriopathy. European Journal of Neurology, 14 (8), 937939.Google Scholar
Shobha, N., Smith, E.E., Demchuk, A.M., & Weir, N.U. (2009). Small vessel infarcts and microbleeds associated with radiation exposure. Canadian Journal of Neurological Sciences, 36 (3), 376378.CrossRefGoogle ScholarPubMed