Post-irradiation polyradiculopathy mimics leptomeningeal tumor on MRI

Hsia, Amie W.; Katz, Jonathan; Hancock, Steven; Peterson, Kendra

doi:10.1212/01.wnl.0000063320.61458.d8

Cited by 24 publications

(15 citation statements)

References 9 publications

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“…[5][6][7] The clinical picture was characterized by an insidious onset of neurologic deficits occurring over many The role of the multiple cavernomas in the pathophysiology of nerve fiber damage remains unsettled. Radiation-induced cavernomas could simply be an epiphenomenon not responsible for nerve fiber damage.…”

Section: Discussionmentioning

confidence: 99%

“…Only one patient had back and lower limb pain. 5 EMG was performed in six of eight patients and demonstrated a pure motor radiculopathy with decreased amplitudes of motor potentials, normal conduction velocities, and normal sensory potentials of the lower extremities in all patients. These clinical and EMG findings are reminiscent of the "postirradiation lower motor neuron syndrome" reported by Bowen et al 1 On MRI, the lesions were suggestive of meningeal dissemination along the cauda equina with a T1 isointense signal and a diffuse, nodular gadolinium enhancement without hypointense rim on either T2-or T2* (T2 Star)-weighted MRI.…”

Section: Casementioning

confidence: 95%

“…These clinical and EMG findings are reminiscent of the "postirradiation lower motor neuron syndrome" reported by Bowen et al 1 On MRI, the lesions were suggestive of meningeal dissemination along the cauda equina with a T1 isointense signal and a diffuse, nodular gadolinium enhancement without hypointense rim on either T2-or T2* (T2 Star)-weighted MRI. [5][6][7] Unlike carcinomatous meningitis, however, postcontrast enhancement was faint, and all of the radiologic abnormalities were restricted to the radiation field, as demonstrated by the signal conversion of vertebral bone marrow on both T1-and T2-weighted images. 8 Furthermore, this ominous radiologic finding was discordant with the slowly progressive clinical course, the repeatedly negative cytologic CSF analyses (despite elevated protein concentration), and the stable MRI over time.…”

Section: Casementioning

confidence: 99%

“…[1][2][3][4] The differential diagnosis between tumor recurrence and radiation-induced neurologic complication may be challenging. 5 We report cases of three patients with a history of lumbar irradiation who developed a progressive lumbosacral radiculopathy mimicking meningeal carcinomatosis. …”

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confidence: 98%

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Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

Ducray

Guillevin²,

Psimaras³

et al. 2008

Neuro-Oncology

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Lumbosacral radiculopathy is a rare complication of radiotherapy and may be challenging to differentiate from diagnosis of a tumor recurrence. We reviewed the records of three patients with a past history of cancer and radiotherapy who were referred for suspicion of carcinomatous meningitis on lumbar MRI, but whose final diagnosis was radiation-induced lumbosacral radiculopathy. The three patients developed a progressive lumbosacral radiculopathy at 20, 13, and 47 years after lumbar radiotherapy delivered for renal cancer, Hodgkin's disease, and a seminoma, respectively. MRI showed a diffuse, nodular enhancement of the cauda equina nerve roots on T1 sequences, suggestive of leptomeningeal metastasis. A slowly progressive clinical course over several years and negative cerebrospinal fluid cytologic analysis ruled out the diagnosis of carcinomatous meningitis. Because of the radiologic findings, a biopsy was performed in two patients. In the first, a biopsy limited to the arachnoid excluded a malignant infiltration. In the second, a biopsy of the enhancing lesions demonstrated spinal root cavernomas. These observations, together with three recent case reports in the literature, delineate a syndrome of "radiationinduced lumbosacral radiculopathy with multiple spinal root cavernomas" that mimics carcinomatous meningitis on MRI. Its diagnosis is important in order to avoid inappropriate treatment and useless or dangerous spinal root biopsies.

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Section: Discussionmentioning

confidence: 99%

Section: Casementioning

confidence: 95%

Section: Casementioning

confidence: 99%

mentioning

confidence: 98%

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Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

Ducray

Guillevin²,

Psimaras³

et al. 2008

Neuro-Oncology

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“…In the cancer population, radiation injury and opportunistic infections (tuberculosis, cryptococcal infections) are important mimickers of spinal LM on imaging. Other diseases that produce similar MRI enhancement include meningitis, granulomatosis angiitis, Wegener's granulomatosis, vasculitis, sarcoidosis, amyloidosis, histiocytosis, Lyme disease, renal failure, spontaneous intracranial hypotension, and recent seizures [28,29].…”

Section: Diagnostic Work-upmentioning

confidence: 99%

Leptomeningeal metastases

Demopoulos

2004

Curr Neurol Neurosci Rep

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Leptomeningeal metastasis, also known as neoplastic meningitis, carcinomatous meningitis, and meningeal carcinomatosis, occurs when cancer cells gain access to cerebrospinal fluid pathways, travel to multiple sites within the central nervous system, settle, and grow. This disease has become an increasingly important late complication in oncology as patients survive longer, develop more brain metastases, and newer chemotherapies fail to penetrate the blood-brain barrier. The hallmark of clinical presentation is a cancer patient who complains of focal neurologic dysfunction and is found to have multifocal signs on neurologic examination. The clinical course is relentlessly progressive; treatment is limited and cures are the subject of case reports. This article reviews the clinical course of leptomeningeal metastasis and addresses recent developments in its pathophysiology, diagnosis, and treatment.

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