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A difficult case
Iatrogenic cerebral radiation necrosis
  1. Carolina Maria Helena Hilton1,
  2. Lena Specht1,
  3. Eva Loebner Lund2,
  4. Pernille Christina Martens3,
  5. Grethe Schmidt4,
  6. Lars-Henrik Krarup5
  1. 1 Department of Oncology, Rigshospitalet, København, Denmark
  2. 2 Department of Pathology, Rigshospitalet, København, Denmark
  3. 3 Department of Radiology, Rigshospitalet, København, Denmark
  4. 4 Department of Plastic Surgery and Burns Treatment, Rigshospitalet, København, Denmark
  5. 5 Department of Neurology, Rigshospitalet, København, Denmark
  1. Correspondence to Lars-Henrik Krarup, Department of Neurology, Rigshospitalet, København, Denmark; lars-henrik.krarup.01{at}regionh.dk

Abstract

Cerebral radiation necrosis is the most serious late reaction to high doses of ionising radiation to the brain, and its treatment is generally unsatisfactory. We present a patient who developed cerebral radiation necrosis after protracted fluoroscopy during repeated embolisations of an extracranial arteriovenous malformation. Treatment with bevacizumab (a humanised murine monoclonal antibody against vascular endothelial growth factor) was followed by neurological and radiological improvements.

  • cerebrovascular
  • MR
  • neuropathology
  • radiotherapy

http://dx.doi.org/10.1136/practneurol-2020-002904

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    Footnotes

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer We used the CARE checklist when writing our report.

    • Competing interests LS is on advisory board for Takeda, MSD and Kyowa Kirin; received honoraria from Merck Darmstadt, MSD, Takeda and Kyowa Kirin; and has research agreements with Varian and ViewRay.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Robin Grant, Edinburgh, UK, and Fiona McKevitt, Sheffield, UK.

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