J Korean Neurosurg Soc.  2015 Mar;57(3):215-218. 10.3340/jkns.2015.57.3.215.

Delayed Diagnosis of Probable Radiation Induced Spinal Cord Vascular Disorders

• Won YI
• Kim CH
• Chung CK
• Yun TJ

• KMID: 2191225
• DOI: http://doi.org/10.3340/jkns.2015.57.3.215

Abstract

Occasionally, unexpected neurological deficits occur after lumbar spinal surgery. We report a case of monoparesis after lumbar decompressive surgery. A 63-year-old man, who had undergone decompression of L4-5 for spinal stenosis 4 days previously in the other hospital, visted the emergency department with progressive weakness in the left leg and hypoesthesia below sensory level T7 on the right side. He had been cured of lung cancer with chemotherapy and radiation therapy 10 years previously, but detailed information of radiotherapy was not available. Whole spine magnetic resonance (MR) imaging showed fatty marrow change from T1 to T8, most likely due to previous irradiation. The T2-weighted MR image showed a high-signal T4-5 spinal cord lesion surrounded by a low signal rim, and the T1-weighted MR image showed focal high signal intensity with focal enhancement. The radiological diagnosis was vascular disorders with suspicious bleeding. Surgical removal was refused by the patient. With rehabilitation, the patient could walk independently without assistance 2 months later. Considering radiation induced change at thoracic vertebrae, vascular disorders may be induced by irradiation. If the spinal cord was previously irradiated, radiation induced vascular disorders needs to be considered.

Keyword

Cavernous malformation; Radiation therapy; Spinal cord; Vascular disorders

MeSH Terms

Bone Marrow
Decompression
Delayed Diagnosis*
Diagnosis
Drug Therapy
Emergency Service, Hospital
Hemorrhage
Humans
Hypesthesia
Leg
Lung Neoplasms
Middle Aged
Paresis
Radiotherapy
Rehabilitation
Spinal Cord*
Spinal Stenosis
Spine
Thoracic Vertebrae

Figure

• 

  Fig. 1 Magnetic resonance imaging from the 63-year-old man with spinal cord cavernous malformation. A hyperintense intramedullary lesion (black arrowhead) is surrounded by hypointense rim by hemosiderin is seen at the T4-5 level on the T2-weighted sagittal magnetic resonance (MR) image (A). The lesion at T4-5 also shows hyperintensity on the T1-weighted MR image (black arrowhead), and which suggests recent hemorrhage (B). The lesions (arrowhead, C and arrow, E) showed irregular enhancement in T1-weighted sagittal and axial images (C, D, and E). Localized fatty marrow change from T1 to T8 vertebral bodies due to previous irradiation is also noted on the T1 and T2-weighted sagittal MR images (A and B). Another ill-defined high signal intensity change on the T2-weighted sagittal MR image at T5-6 spinal cord shows normal diameter of the spinal cord without edema, and a sequela of previous irradiation is suspected (black arrow, A).

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