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Fulminant Strokes Secondary to Radiation-induced Small-vessel Arteriopathy

Published online by Cambridge University Press:  02 May 2014

Charles D. Kassardjian*
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Ari Breiner
Affiliation:
University of Toronto, Toronto, Ontario, Canada Toronto General Hospital, Toronto, Ontario, Canada
Martin del Campo
Affiliation:
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: charles.kassardjian@utoronto.ca
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Abstract

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.

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

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