Reversible Oedema and Necrosis after Irradiation of the Brain Diagnostic Procedures and Clinical Manifestations

Rapid Progression of Early Delayed Radiation Effect in Pleomorphic Xanthoastrocytoma

“…In the present case, the MRI changes involving both edema and contrast enhancement occurred only one month after irradiation. This is unique since the early delayed effects reported previously were observed at least three months after completing radiotherapy 2,23) . In addition, there was a possibility that initial diagnosis determined after initial biopsy was incorrect, for example, undergrading of high grade tumor, since such an early progression of low grade tumor is unusual, and these made us perform the second biopsy for differential diagnosis.…”

“…Because these symptom and signs resolve spontaneously with only conservative management within a few weeks, it is important to suspect the early delayed reaction to irradiation 13,23) . Failure to recognize this may lead to administering adjuvant treatments such as chemotherapy, further irradiation, or recraniotomy that can aggravate the symptoms and cause neurological deficits.…”

“…Failure to recognize this may lead to administering adjuvant treatments such as chemotherapy, further irradiation, or recraniotomy that can aggravate the symptoms and cause neurological deficits. On the imaging study, the radiation effect in the early delayed period is also reversible and this may or may not be enhanced with contrast administration 2,23) . Watne et al 23) reported on six patients with early delayed effects of radiation.…”

“…On the imaging study, the radiation effect in the early delayed period is also reversible and this may or may not be enhanced with contrast administration 2,23) . Watne et al 23) reported on six patients with early delayed effects of radiation. They observed that the CT scan changes were seen at 4 to 8 A B C months after irradiation, followed by regression about 3 months later.…”

“…In addition, there was a possibility that initial diagnosis determined after initial biopsy was incorrect, for example, undergrading of high grade tumor, since such an early progression of low grade tumor is unusual, and these made us perform the second biopsy for differential diagnosis. In fact, the diagnostic error of stereotactic biopsy has been reported in 3-49% of cases 2,6,10,12,15,23) . One recent study documented that there was no evidence of hyperintensities on MRI, as might be expected from the radiation therapy during the months after its completion 1) .…”