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一名儿童髓母细胞瘤长期幸存者放射性脑脊髓病的病例报告

A Case Report on Radiation-Induced Cerebral Vasculopathy in a Long-Term Survivor of Childhood Medulloblastoma.

作者信息

Esteves Sara C, Szymanski Kathryn A, Kuwabara Michael S

机构信息

Neuroradiology, Creighton University School of Medicine, Phoenix, USA.

Neuroradiology, Phoenix Children's Hospital, Phoenix, USA.

出版信息

Cureus. 2024 Aug 30;16(8):e68213. doi: 10.7759/cureus.68213. eCollection 2024 Aug.

DOI:10.7759/cureus.68213
PMID:39347355
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11439436/
Abstract

This case report discusses a patient diagnosed with radiation-induced cerebral vasculopathy who presented after cerebral irradiation of metastatic medulloblastoma to raise awareness of radiation-induced cerebral vasculopathy. Because radiation therapy has revolutionized treatment for children with brain cancers, radiation-induced vasculopathy is becoming ever more prominent, and its recognition is crucial to implementing early treatment strategies to improve patient outcomes. Currently, medical management is poorly defined, largely unexamined, and poorly studied. Because the clinical features of this disease are nonspecific, radiation-induced cerebral vasculopathy remains a diagnosis of exclusion and an essential addition to the differential diagnosis. Discussion regarding standardized treatment, screening, and guidelines is necessary to improve treatment and survival.

摘要

本病例报告讨论了一名被诊断为放射性脑脊髓病的患者，该患者在转移性髓母细胞瘤脑照射后出现症状，旨在提高对放射性脑脊髓病的认识。由于放射治疗彻底改变了儿童脑癌的治疗方式，放射性血管病日益突出，认识到这一点对于实施早期治疗策略以改善患者预后至关重要。目前，药物治疗的定义不明确，大多未经检验，且研究较少。由于这种疾病的临床特征不具有特异性，放射性脑脊髓病仍然是一种排除性诊断，也是鉴别诊断中必不可少的一项。关于标准化治疗、筛查和指南的讨论对于改善治疗和提高生存率是必要的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/62847f8b0d89/cureus-0016-00000068213-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/0a9ae7042205/cureus-0016-00000068213-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/58d03e499436/cureus-0016-00000068213-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/1e4bf702744d/cureus-0016-00000068213-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/62847f8b0d89/cureus-0016-00000068213-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/0a9ae7042205/cureus-0016-00000068213-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/58d03e499436/cureus-0016-00000068213-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/1e4bf702744d/cureus-0016-00000068213-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa3c/11439436/62847f8b0d89/cureus-0016-00000068213-i04.jpg

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本文引用的文献

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Review of Cerebral Radiotherapy-Induced Vasculopathy in Pediatric and Adult Patients.小儿及成人患者脑放疗诱发血管病变的综述
Adv Biol (Weinh). 2023 Oct;7(10):e2300179. doi: 10.1002/adbi.202300179. Epub 2023 Jul 4.
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A Case of Occlusive Radiation Vasculopathy Presenting as Bilateral Internal Carotid Artery, Left Middle Cerebral Artery Occlusion and Literature Review.
一例表现为双侧颈内动脉、左侧大脑中动脉闭塞的放射性闭塞性血管病病例及文献复习
Case Rep Neurol. 2020 Dec 14;12(Suppl 1):91-96. doi: 10.1159/000501902. eCollection 2020 Sep-Dec.
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Harnessing genome-wide association studies to minimize adverse radiation-induced side effects.利用全基因组关联研究将辐射引起的不良副作用降至最低。
Radiat Oncol J. 2020 Dec;38(4):226-235. doi: 10.3857/roj.2020.00556. Epub 2020 Nov 25.
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Radiation-Induced Endothelial Vascular Injury: A Review of Possible Mechanisms.辐射诱导的内皮血管损伤：可能机制综述
JACC Basic Transl Sci. 2018 Aug 28;3(4):563-572. doi: 10.1016/j.jacbts.2018.01.014. eCollection 2018 Aug.
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J Neurosurg. 2018 Jun 1;130(6):1889-1897. doi: 10.3171/2017.12.JNS172635. Print 2019 Jun 1.
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Review of cranial radiotherapy-induced vasculopathy.颅脑放疗所致血管病变的综述。
J Neurooncol. 2015 May;122(3):421-9. doi: 10.1007/s11060-015-1732-2. Epub 2015 Feb 12.
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Radiation-induced arteritis: thickened wall with prominent enhancement on cranial MR images report of five cases and comparison with 18 cases of Moyamoya disease.放射性动脉炎：头颅磁共振成像显示血管壁增厚且强化明显——5例报告并与18例烟雾病对比
Radiology. 2002 Jun;223(3):683-8. doi: 10.1148/radiol.2233010822.