Radiation-induced leukoencephalopathy and cerebral vasculopathy
Presents with progressive brainstem signs
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Prior history of nasopharyngeal carcinoma and bone marrow changes within the base of skull and upper cervical spine in keeping with prior radiotherapy. Numerous microhemorrhages also conform to prior radiotherapy, located in the cerebellum, brainstem and temporal poles. This is associated with high T2 signal within the temporal poles further suggestive of a radiotherapy induced leukoencephalopathy. The pons and midbrain demonstrate multiple infarcts with volume loss, presumably also the sequelae of a radiotherapy. Supratentorially, other than the temporal lobes, there is relatively little chronic small vessel ischemic change with a solitary corona radiata infarct on the left. Ventricles are mildly prominent. No intra extra-axial mass or abnormal contrast enhancement.
Conclusion: Extensive change secondary to radiotherapy for nasopharyngeal carcinoma.
This patient had received radiotherapy for a nasopharyngeal carcinoma over 15 years previously.