Ciaudo-Lacroix C, Lapresle J
Ann Med Interne (Paris). 1985;136(2):137-41.
A 60 year-old woman with a scalp epithelioma underwent radiotherapy, the dose being 57 Gray. A first epileptic seizure occurred twenty months later. Neurological examination revealed signs of left hemisphere involvement. gamma EG, angiography, CT scans, demonstrated a pseudotumoral avascular process. On account of the localisation, the patient being right-handed, no surgical procedure was performed. In spite of corticotherapy and anticonvulsive treatment, seizures recurred and neurological signs slowly progressed. The patient died, 22 months after the first seizure, of an associated disseminated carcinoma with cachexia. Neuropathological examination showed a massive lesion presenting all the features of delayed radionecrosis in the left hemisphere: situated mainly in the white matter; numerous vascular abnormalities; wide-spread demyelination; disappearance of oligoglial cells. The Authors recall the clinical and anatomical aspects of this condition for which the only successful treatment is surgical removal when location and size of the lesion permit. Finally, the mechanisms which have been proposed to explain this delayed cerebral radionecrosis are discussed.
一名患有头皮上皮瘤的60岁女性接受了放射治疗，剂量为57格雷。20个月后首次发生癫痫发作。神经学检查发现有左半球受累的迹象。γ脑电图、血管造影、CT扫描显示为假肿瘤性无血管病变。鉴于病变位置，患者为右利手，未进行手术。尽管进行了皮质激素治疗和抗惊厥治疗，但癫痫仍复发，神经体征缓慢进展。患者在首次癫痫发作22个月后死于伴有恶病质的播散性癌。神经病理学检查显示左半球有一个巨大病变，具有迟发性放射性坏死的所有特征：主要位于白质；有许多血管异常；广泛脱髓鞘；少突胶质细胞消失。作者回顾了这种疾病的临床和解剖学方面，当病变的位置和大小允许时，唯一成功的治疗方法是手术切除。最后，讨论了为解释这种迟发性脑放射性坏死而提出的机制。
