ABSTRACT
INTRODUCCIÓN: La radioterapia es un tratamiento de gran utilidad en las neoplasias del sistema nervioso central. El rango temporal de sus complicaciones es muy amplio, ya que aparecen incluso muchos años más tarde de haberla finalizado. Estas complicaciones tardías se comportan clínica y radiológicamente de forma similar a una recidiva; un estudio funcional diagnóstico con isótopos radiactivos puede ayudar a tomar una decisión terapéutica. CASO CLÍNICO: Varón que presentó de forma brusca sintomatología neurológica deficitaria en la misma localización donde 25 años antes había recibido radioterapia por un astrocitoma pilocítico. La resonancia magnética sugería un ictus lacunar, pero un hallazgo en la secuencia de perfusión obligaba a ser más preciso en el diagnóstico. Una tomografía por emisión de positrones-tomografía computarizada (PET-TC) con C11-metionina mostró un aumento de captación compatible con neoplasia. La evolución espontánea regresiva de los síntomas inclinó a tomar una actitud conservadora. Una resonancia magnética realizada tres meses más tarde confirmó el ictus lacunar. CONCLUSIONES: La reaparición de síntomas neurológicos años más tarde de la radioterapia de una neoplasia cerebral supone un dilema diagnóstico. Las técnicas diagnósticas actuales son muy precisas, pero presentan falsos positivos. Las distintas técnicas de medicina nuclear, en concreto la PET-TC con C11-metionina, suponen una ayuda diagnóstica. Con este caso se pretende llamar la atención sobre una de las complicaciones tardías de la radioterapia y los distintos diagnósticos diferenciales. Los avances diagnósticos y terapéuticos han aumentado la esperanza de vida de los pacientes oncológicos, con lo que estas complicaciones tardías se prevén más frecuentes
INTRODUCTION: Radiation therapy is a very useful treatment for central nervous systems neoplasms. The time range of its complications is very wide; they appear even many years after its completion. These late complications behave clinically and radiologically similar to a relapse; a functional diagnostic study with radioactive isotopes can help to make a therapeutic decision. CASE REPORT: A male suddenly presented deficient neurological symptoms in the same site where he received radiation therapy 25 years earlier for a pilocytic astrocytoma. The MRI findings suggested a lacunar stroke but a finding in the perfusion sequence forced us to be more precise in the diagnosis. A PET-CT 11C-methionine was performed which showed an increased uptake compatible with neoplasia. The spontaneous regressive evolution of the symptoms inclined us to take a conservative attitude. Lacunar ictus was confirmed on MRI three months later. CONCLUSIONS: The reappearance of neurological symptoms years after radiotherapy of a brain neoplasm poses a diagnostic dilemma. Current diagnostic techniques are very accurate but present false positives. The various nuclear medicine techniques, in particular PET-CT 11C-methionine, are a diagnostic aid. With the presentation of this case we intend to draw attention to one of the late complications of radiation therapy and the various differential diagnoses. Diagnostic and therapeutic advances have increased the life expectancy of cancer patients, so these late complications are expected to be more frequent
Subject(s)
Humans , Male , Adult , Stroke, Lacunar/etiology , Astrocytoma/radiotherapy , Brain Neoplasms/radiotherapy , Radiation Injuries/etiology , Stroke, Lacunar/diagnostic imaging , Magnetic Resonance Imaging , Positron Emission Tomography Computed Tomography , Risk FactorsABSTRACT
Pleomorphic xanthoastrocytoma (PXA) is a brain neoplasm included in the astrocytic group, exceptionally manifesting with meningeal dissemination. We described a 27-year-old patient presented with acute bilateral visual loss and papilledema with normal brain computed tomography scan, initially mimicking idiopathic intracranial hypertension (IIH). Brain and spinal cord magnetic resonance imaging (MRI) study revealed a subtle area of hyperintensity of the gyri surrounding the left central sulcus, and contrast enhancement of the thoracic leptomeninges. Brain biopsy of the parietal lesion revealed nonanaplastic PXA. Treatment with temozolomide was given. Yearly control MRI demonstrated new brain lesions and marked progression of leptomeningeal spinal enhancement. In spite of this, the patient has remained stable with no new symptoms. Nonanaplastic PXA may present with widespread meningeal dissemination with acute visual loss and papilledema mimicking IIH, and no clinical progression at 3 years.
Subject(s)
Astrocytoma/pathology , Astrocytoma/therapy , Blindness/etiology , Brain Neoplasms/pathology , Brain Neoplasms/therapy , Headache/etiology , Ventriculoperitoneal Shunt , Adult , Astrocytoma/complications , Blindness/diagnosis , Blindness/prevention & control , Brain Neoplasms/complications , Combined Modality Therapy , Dacarbazine/analogs & derivatives , Dacarbazine/therapeutic use , Headache/diagnosis , Headache/prevention & control , Humans , Male , Temozolomide , Treatment OutcomeABSTRACT
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