Dados do Trabalho

Título

Early inflammatory changes in the brainstem after radiosurgery: a case report

RESUMO

Presentation of the case: A 36-year-old woman, without previous comorbidities, was diagnosed with a right petroclival meningioma, who underwent radiosurgery. 30 days after the procedure, she was admitted with initial complaints of vertigo, followed by sensory changes on left hemibody and diplopia. On neurological examination, there were right horizontal gaze-evoked nystagmus, with binocular diplopia, right sensorineural hypoacusia, paresis of the palate elevation on the left, and asymmetry on shoulder elevation, worse on the left. Motor strength was preserved on the four limbs. There was tactile and painful hypoesthesia on the left hemibody, with deep senses preserved. There was no axial or appendicular ataxia, but a shift to the left on Fukuda gait. CSF disclosed a slight increase in cellularity and protein. MRI showed a hypersignal on T2-weighted images of the brainstem and cerebellar peduncle. Pulse therapy was performed with 1g of methyprednisolone for 05 days, with significant improvement in symptoms.
Discussion: Inflammatory changes in the brainstem admit a wide differential diagnosis and may be challenging. Imaging changes on MRI are common after CNS radiation and can be seen as a hypersignal on T2-weighted images. However, only about 10% of patients are symptomatic and presented with cranial neuropathies, headache, hemorrhages, edema, epileptic seizures, radionecrosis, among others. Radiation complications can be acute (radiation encephalopathy), subacute (transient demyelination) or chronic. Radionecrosis, the most common chronic complication, especially in the brainstem, is rare and atypical presentations are even less frequent. Usually, radionecrosis occurs about 6 months to 3 years after treatment. First-line therapy is with corticosteroids.
Closing remarks: Acute complications related to radiotherapy are uncommon. Later complications, such as radionecrosis, occur in about 23.1% of cases, in the first year up to decades after treatment. Attention is required for this presentation reported here, in view of its wide differential diagnosis and favorable prognosis after treatment with corticosteroids.

Palavras Chave

Inflamatory changes, radiosurgery, radionecrosis