Department of Neurology and Neuromuscular Service, Tel Aviv Medical Center, Tel Aviv, Israel.
J Neurol. 2013 Jul;260(7):1802-6. doi: 10.1007/s00415-013-6881-7. Epub 2013 Mar 5.
A variety of neurological syndromes has been described after irradiation of the distal spinal cord and cauda equina, mainly as treatment for testicular cancer and lymphoma. One of these syndromes is a rare lower motor neuron syndrome, manifested by flaccid paraparesis. Medical files of patients with postradiation lower motor neuron syndrome treated in our neuromuscular clinic from 2005 to 2012 were reviewed. The diagnosis was based on past irradiation of the distal spinal cord and cauda equina, slowly progressive lower limb weakness, characteristic electrophysiological studies, and no alternative diagnosis. In addition, a systematic review of the literature on similar cases was performed using PUBMED. We identified five patients with postradiation lower motor neuron syndrome in our clinic charts. Three of them were irradiated due to seminoma, and the other two due to lymphoma. 45 additional similar cases were found in a literature search, mainly male (89 %), with testicular cancer (67 %), irradiated at mean age of 33 years, with an average irradiation dose of 5,225 cGy (range 3,000-14,600), and a latency period between irradiation and symptoms onset ranging from 3 months to 27 years (average 9 years). Magnetic resonance imaging was done only in few, showing gadolinium enhancement of the cauda equina in close to half of them (7/16). Our patients and those previously described in the literature form a distinct clinical and electrophysiological syndrome that might be more frequent then previously expected, and should be not overlooked.
多种神经系统综合征已被描述为脊髓远端和马尾照射后的并发症，主要是作为治疗睾丸癌和淋巴瘤的手段。其中一种综合征是一种罕见的下运动神经元综合征，表现为弛缓性截瘫。我们回顾了 2005 年至 2012 年间在神经肌肉诊所治疗的放射性下运动神经元综合征患者的医疗档案。该诊断基于脊髓远端和马尾的既往照射、下肢进行性无力、特征性的电生理研究，以及无其他替代诊断。此外，还使用 PUBMED 对类似病例的文献进行了系统回顾。我们在诊所图表中发现了五例放射性下运动神经元综合征患者。其中三人因精原细胞瘤接受照射，另外两人因淋巴瘤接受照射。在文献检索中还发现了 45 例类似病例，主要为男性（89%），患有睾丸癌（67%），平均年龄为 33 岁，平均照射剂量为 5225cGy（范围 3000-14600），照射后至症状出现的潜伏期为 3 个月至 27 年（平均 9 年）。仅少数患者进行了磁共振成像，其中近一半（7/16）显示马尾增强。我们的患者和以前文献中描述的患者形成了一种独特的临床和电生理综合征，其可能比以前预期的更常见，不应被忽视。
