A Case of Occlusive Radiation Vasculopathy Presenting as Bilateral Internal Carotid Artery, Left Middle Cerebral Artery Occlusion and Literature Review

Huang, Yung-Chuan; Huang, Shin-Leh; Liu, Hon‐Man; Chiu, Hou‐Chang

doi:10.1159/000501902

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…Second, the diameter of the brainstem perforators is substantially smaller (80 to 840 µm) than that of the internal carotid artery (ICA; 4 to 6 mm). [28][29][30] This may also explain why the posterior circulation may be more susceptible to atherosclerosis-related vascular occlusion. Third, early identification of pathological changes, such as plaque formation and stenosis, in the posterior circulation may be challenging because the cranial and vertebral bony structures limit their visualization on transcranial Doppler ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Increased Risks of Large-Artery Atherosclerosis and Brainstem Stroke in Patients With Nasopharyngeal Carcinoma

Lin,

Liang

et al. 2023

Preprint

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Background: Information about the characteristics of stroke is crucial for improved screening, prevention, and treatment. The pattern of ischemic stroke in patients with nasopharyngeal carcinoma (NPC) is not well understood. The objective of this study is to investigate the etiology of ischemic stroke and the affected vascular territories in patients with NPC. Methods: The Taiwan National Health Insurance Research Database and the Taiwan Stroke Registry were combined to identify the following 2 cohorts: patients with NPC having a subsequent stroke (NPC cohort) and patients without NPC having a stroke (non-NPC cohort). Data pertaining to the period from 2006 to 2018 were analyzed. The TOAST (Trial of ORG 10?172 in Acute Stroke Treatment) subtype of ischemic stroke and the affected vascular territories were analyzed and compared between the 2 cohorts. Results: The NPC cohort comprised 277 patients, whereas the non-NPC cohort comprised 125 024 patients. The most common TOAST subtype of ischemic stroke was large-artery atherosclerosis (LAA) in the NPC cohort and small-vessel occlusion in the non-NPC cohort. The prevalence of LAA was considerably higher in the NPC cohort (41.9%) than in the non-NPC cohort (28.3%). The analysis of the affected vascular territories revealed that the incidence of brainstem stroke was significantly higher in the NPC cohort (25.4%) than in the non-NPC cohort (14.5%). Conclusions: Patients with NPC tend to have increased risks of LAA and brainstem ischemic stroke. Physicians should consider sparing the vertebral and basilar arteries during definitive radiotherapy for NPC. Long-term follow-up for patients with NPC may include brain magnetic resonance imaging. This study may guide radiation oncologists in clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Increased Risks of Large-Artery Atherosclerosis and Brainstem Stroke in Patients With Nasopharyngeal Carcinoma

Lin,

Liang

et al. 2023

Preprint

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“…Radiologically, radiation-induced vascular changes are not distinguishable from primary moyamoya syndrome [ 9 ]. Patients receiving adjunctive chemotherapy, receiving radiotherapy at a young age, receiving a higher radiation dose, or having other vascular risk factors are among the risk factors for developing radiation-induced vasculopathy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Radiation-Induced Vasculopathy Mimicking Primary Central Nervous System Vasculitis

Abdulghaffar,

Alqarni,

Altwirgi

et al. 2023

Cureus

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Cranial irradiation is one of the main treatment modalities for tumors of the CNS. However, it can lead to significant damage to the treated region. Among the late complications of radiation therapy to the brain is vasculopathy of the small and/or large arteries. In this article, we report a case of CNS radiation-induced vasculopathy presenting 30 years after cranial irradiation and mimicking primary CNS vasculitis. The present case illustrates the importance of monitoring and carefully evaluating delayed side effects of radiotherapy as well as emphasizes the importance of obtaining a detailed history of any patient presenting with sudden unexplained symptoms. If a complete proper history of the patient’s past medical diagnoses and procedures was taken, medical professionals would not have needed to conduct extensive investigations and implement treatment plans for a less likely diagnosis, in this case, aggressive treatment of a possible primary CNS vasculitis with high-dose steroids. Therefore, it is imperative to raise the possibility of radiation-induced vasculopathy after excluding all possible causes of deterioration in patients with a history of cranial radiation therapy.

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The Natural History of Carotid Artery Occlusions Diagnosed on Duplex Ultrasound

Speranza¹,

Harish²,

Rockman³

et al. 2023

Annals of Vascular Surgery

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A Case of Occlusive Radiation Vasculopathy Presenting as Bilateral Internal Carotid Artery, Left Middle Cerebral Artery Occlusion and Literature Review

Cited by 4 publications

References 14 publications

Increased Risks of Large-Artery Atherosclerosis and Brainstem Stroke in Patients With Nasopharyngeal Carcinoma

Increased Risks of Large-Artery Atherosclerosis and Brainstem Stroke in Patients With Nasopharyngeal Carcinoma

Cerebral Radiation-Induced Vasculopathy Mimicking Primary Central Nervous System Vasculitis

The Natural History of Carotid Artery Occlusions Diagnosed on Duplex Ultrasound

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