Kantonsspital St.Gallen
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Radiation-induced cavernoma after total body irradiation and haematopoietic stem cell transplantation in an adult patient suffering from acute myeloid leukaemia

Thomas Hundsberger, Johannes Weber, Barbara Tettenborn & Julia Walch

abstract Cerebral cavernomas are thin-walled vascular lesions composed of dilated
capillary spaces. De novo formation of cavernomas after cerebral radiotherapy has
been suspected since 1994. They are mostly seen in children after irradiation of brain
tumours. Radiation dose and the developing juvenile brain are predisposing factors
causing cavernomas. However, the underlying mechanisms are still far from being
understood. In adults, radiation-induced cavernomas usually occur ten years after
higher cumulative radiation dosage >30 Gray.
We here report a 45-year-old man with new onset of focal epileptic seizures caused
by a hemorrhagic lesion on cerebral CT scan. Brain MRI showed the typical
appearance of a ruptured cavernoma. Of note, a cerebral MRI scan five years earlier
showed no corresponding lesion. The patient was treated with haematopoietic stem
cell transplantation for acute myeloid leukaemia 16 years ago. As part of this
procedure total body irradiation with 12 Gy was administered. According to the data
from the literature the typical delay from irradiation and a former normal brain MRI
scan we assume that our patient suffers from a radiation-induced cavernoma. We
here report the first documented adult AML-patient with a radiation-induced
cavernoma treated with total body radiation so far. We aim to increase the alertness
among neurologists of the association of cranial or whole body irradiation and de
novo cavernomas in patients suffering from malignant diseases.
   
citation Hundsberger T, Weber J, Tettenborn B, Walch J. Radiation-induced cavernoma after total body irradiation and haematopoietic stem cell transplantation in an adult patient suffering from acute myeloid leukaemia. Case Reports in Neurology 2013; 5:91-97.
   
type journal paper/review (English)
date of publishing 18-4-2013
journal title Case Reports in Neurology (5)
pages 91-97