Radiation myelopathy.

Sanyal, B; Pant, G C; Subrahmaniyam, K; Agrawal, Manasi; Mohanty, Supriya

doi:10.1136/jnnp.42.5.413

Cited by 12 publications

(5 citation statements)

References 22 publications

(30 reference statements)

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“…Type 3 lesions involve the simultaneous occurrence of the above-mentioned two types of injuries. Besides white matter reactions, grey matter sequelae (neuronal degeneration, chromatolysis, and a coarse tigroid appearance of the Nissl substance) may also occur in the anterior and posterior horns of the spinal cord, [4][5][6][7]11,13 but the grey matter per se is less radiosensitive than the white matter. [4][5][6]11 Tables 1 and 2 present data on 17 cases of Type 1 lesions and 10 cases of Type 2 injuries, collected from the English literature.…”

Section: Discussionmentioning

confidence: 99%

“…The most marked damage generally involves the large motor neurones of the anterior horns, resulting in consecutive flaccid paresis. [4][5][6][7][11][12][13] Radiation myelopathy usually runs a chronic, progressive, irreversible and relentless clinical course, with only rare recovery from established motor sequelae. A thorough literature search unearthed only seven welldocumented published cases of remission.…”

Section: Introductionmentioning

confidence: 99%

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Autopsy verifies demyelination and lack of vascular damage in partially reversible radiation myelopathy

Lengyel

Rékó²,

Majtenyi³

et al. 2003

Spinal Cord

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Study design: Case report of recovering radiation myelopathy. Objective: To present autopsy and functional imaging findings on a unique case of slowly recovering radiation myelopathy with the aim of the clarification of the underlying mechanism. Patient: The cervical spinal cord and the distal part of the medulla oblongata of a 36-year-old thyroid cancer patient had been incorrectly irradiated with a total dose of 61 Gy and a fraction size of 3.4 Gy (J Neurol Sci 1999; 163:39-43), resulting in incomplete cervical transection with a 5-month latency period following the termination of radiotherapy. This was followed by a 9.5-year spontaneous improvement until her demise, during which the check-ups were supplemented by positron emission tomography (PET) investigations; these indicated increased Results: Autopsy revealed demyelination (with axonal loss) and neuronal damage in the cervical spinal cord and the distal part of the medulla oblongata. In the same region, only minimal vascular injury (thickening of some of the capillary walls) was detected, but not cell proliferation or chronic inflammation. Bilateral, secondary pyramidal tract degeneration caudal to the irradiated segment was observed. The PET and autopsy findings, although separated by 2 years, are consistent. Conclusions: The pathological state of the spinal cord revealed by the autopsy is concordant with the incomplete cervical transection, implying that the functional recovery is supported by a process that probably differs from the restoration of the mechanism destroyed by the radiotherapy. For the restoration of the function, we suggest an altered conduction mechanism of the action potential, involving an increased number of sodium channels along the demyelinated segments of the injured axons, which is fully congruent with the PET findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autopsy verifies demyelination and lack of vascular damage in partially reversible radiation myelopathy

Lengyel

Rékó²,

Majtenyi³

et al. 2003

Spinal Cord

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“…Earlier case series have led to suggested safety thresholds for irradiating neural tissue (Friedman, 1954;Pallis et al, 1961;Maier et al, 1969;Ellis, 1971;Schiodt and Kristensen, 1978;Sanyal et al, 1979). A midplane tissue dose of 40 Gy to the thoracolumbar region in 20 fractions over 28 days with (^Co) has been recommended as a suitable threshold to avoid leg weakness (Maier et al, 1969).…”

Section: Radiation Tolerancementioning

confidence: 99%

The Post-irradiation lower motor neuron syndrome Neuronopathy or radiculopathy?

Bowen¹,

Gregory²,

Squier³

et al. 1996

Brain

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It is not known whether the post-irradiation lower motor neuron syndrome results from radiation damage to motor neuron cell bodies or from damage to the nerve roots of the cauda equina. We studied six cases who had presented with testicular neoplasms, subsequently undergoing irradiation that encompassed inter alia para-aortic nodes with co-irradiation of the distal spinal cord and cauda equina. A predominantly motor disorder affecting the legs ensued after variable and often prolonged latencies (3-25 years). However, all patients also developed mild sensory features either initially or on prolonged follow-up. Sural sensory nerve action potentials (SNAPs) were normal in five. Mild sphincter symptoms occurred in three of five surviving cases after a mean of 7.9 years. MRI showed gadolinium enhancement of the cauda equina in two of three patients. The first reported neuropathological study, uncomplicated by metastatic disease, of the conus and cauda equina was performed in one patient who died. This showed a radiation-induced vasculopathy of the proximal spinal roots, with preservation of motor neuronal cell bodies and spinal cord architecture. These clinical, radiological, neurophysiological and pathological findings all point to a predominantly, but not exclusively, motor radiculopathy affecting the irradiated portion of the cauda equina proximal to the dorsal root ganglia. Radiation exposure exceeded 40 Gy both in our series and in previous reports. The natural history of this disorder is one of relentless deterioration occasionally punctuated by 1-2-year periods of stability. Post-irradiation lumbosacral radiculopathy is a more accurate name for this condition.

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“…In these cases, the gray matter injuries are manifested primarily in the arms. [1][2][3][4]8,9 In most cases of radiogenic LMND, however, the only clinical sign of the radiation injury [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] is the flaccid paresis. The disease involves basically the legs, exhibiting a chronic, progressive and irreversible clinical course.…”

Section: Introductionmentioning

confidence: 99%