Stroke-like events after brain radiotherapy: a large series with long-term follow-up

A L Di Stefano, G Berzero, F Ducray, M Eoli, A Pichiecchio, L M Farina, V Cuccarini, M C Brunelli, L Diamanti, S Condette Auliac, A Salmaggi, A Silvani, B Giometto, A Pace, A Vidiri, F Bourdain, S Bastianello, M Ceroni, E Marchioni

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Patients with a history of brain radiotherapy can experience acute stroke-like syndromes related to the delayed effects of brain radiation, including stroke-like migraine attacks after radiation therapy syndrome, peri-ictal pseudoprogression and acute late-onset encephalopathy after radiation therapy syndrome. The aim of this study was to collect evidence on the long-term outcome and treatment of these conditions, whose knowledge is undermined by their rarity and fragmented description.

METHODS: Cases were collected, both prospectively and retrospectively, amongst six neuro-oncology departments. Inclusion criteria were as follows: (i) history of brain radiotherapy (completed at least 6 months before the acute episode); (ii) new onset of acute/subacute neurological symptoms; (iii) exclusion of all etiologies unrelated to brain irradiation. A review of current literature on stroke-like syndromes was performed to corroborate our findings.

RESULTS: Thirty-two patients with acute neurological conditions attributed to the delayed effects of radiation were identified, including 26 patients with stroke-like syndromes. Patients with stroke-like syndromes commonly presented with a mosaic of symptoms, including focal deficits (77%), encephalopathy (50%), seizures (35%) and headache (35%). Seventy-three percent of them had acute consistent magnetic resonance imaging alterations. Treatment included high-dose steroids in 65% of cases. Twenty-two patients recovered completely (85%). Sixteen patients (62%) experienced relapses (median follow-up 3.5 years). A literature review identified 87 additional stroke-like cases with similar characteristics.

CONCLUSIONS: Stroke-like events related to brain irradiation may be associated with permanent sequelae. Steroids are often administered on empirical grounds, as they are thought to accelerate recovery. Relapses are common, highlighting the need to elaborate adequate prevention strategies.

Original languageEnglish
Pages (from-to)639-650
Number of pages12
JournalEuropean Journal of Neurology
Volume26
Issue number4
DOIs
Publication statusPublished - Apr 2019

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Radiotherapy
Stroke
Brain
Radiation Injuries
Radiation Effects
Brain Diseases
Steroids
Recurrence
Migraine Disorders
Headache
Seizures
Magnetic Resonance Imaging

Cite this

Stroke-like events after brain radiotherapy : a large series with long-term follow-up. / Di Stefano, A L; Berzero, G; Ducray, F; Eoli, M; Pichiecchio, A; Farina, L M; Cuccarini, V; Brunelli, M C; Diamanti, L; Condette Auliac, S; Salmaggi, A; Silvani, A; Giometto, B; Pace, A; Vidiri, A; Bourdain, F; Bastianello, S; Ceroni, M; Marchioni, E.

In: European Journal of Neurology, Vol. 26, No. 4, 04.2019, p. 639-650.

Research output: Contribution to journalArticle

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title = "Stroke-like events after brain radiotherapy: a large series with long-term follow-up",
abstract = "BACKGROUND AND PURPOSE: Patients with a history of brain radiotherapy can experience acute stroke-like syndromes related to the delayed effects of brain radiation, including stroke-like migraine attacks after radiation therapy syndrome, peri-ictal pseudoprogression and acute late-onset encephalopathy after radiation therapy syndrome. The aim of this study was to collect evidence on the long-term outcome and treatment of these conditions, whose knowledge is undermined by their rarity and fragmented description.METHODS: Cases were collected, both prospectively and retrospectively, amongst six neuro-oncology departments. Inclusion criteria were as follows: (i) history of brain radiotherapy (completed at least 6 months before the acute episode); (ii) new onset of acute/subacute neurological symptoms; (iii) exclusion of all etiologies unrelated to brain irradiation. A review of current literature on stroke-like syndromes was performed to corroborate our findings.RESULTS: Thirty-two patients with acute neurological conditions attributed to the delayed effects of radiation were identified, including 26 patients with stroke-like syndromes. Patients with stroke-like syndromes commonly presented with a mosaic of symptoms, including focal deficits (77{\%}), encephalopathy (50{\%}), seizures (35{\%}) and headache (35{\%}). Seventy-three percent of them had acute consistent magnetic resonance imaging alterations. Treatment included high-dose steroids in 65{\%} of cases. Twenty-two patients recovered completely (85{\%}). Sixteen patients (62{\%}) experienced relapses (median follow-up 3.5 years). A literature review identified 87 additional stroke-like cases with similar characteristics.CONCLUSIONS: Stroke-like events related to brain irradiation may be associated with permanent sequelae. Steroids are often administered on empirical grounds, as they are thought to accelerate recovery. Relapses are common, highlighting the need to elaborate adequate prevention strategies.",
author = "{Di Stefano}, {A L} and G Berzero and F Ducray and M Eoli and A Pichiecchio and Farina, {L M} and V Cuccarini and Brunelli, {M C} and L Diamanti and {Condette Auliac}, S and A Salmaggi and A Silvani and B Giometto and A Pace and A Vidiri and F Bourdain and S Bastianello and M Ceroni and E Marchioni",
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TY - JOUR

T1 - Stroke-like events after brain radiotherapy

T2 - a large series with long-term follow-up

AU - Di Stefano, A L

AU - Berzero, G

AU - Ducray, F

AU - Eoli, M

AU - Pichiecchio, A

AU - Farina, L M

AU - Cuccarini, V

AU - Brunelli, M C

AU - Diamanti, L

AU - Condette Auliac, S

AU - Salmaggi, A

AU - Silvani, A

AU - Giometto, B

AU - Pace, A

AU - Vidiri, A

AU - Bourdain, F

AU - Bastianello, S

AU - Ceroni, M

AU - Marchioni, E

N1 - © 2018 EAN.

PY - 2019/4

Y1 - 2019/4

N2 - BACKGROUND AND PURPOSE: Patients with a history of brain radiotherapy can experience acute stroke-like syndromes related to the delayed effects of brain radiation, including stroke-like migraine attacks after radiation therapy syndrome, peri-ictal pseudoprogression and acute late-onset encephalopathy after radiation therapy syndrome. The aim of this study was to collect evidence on the long-term outcome and treatment of these conditions, whose knowledge is undermined by their rarity and fragmented description.METHODS: Cases were collected, both prospectively and retrospectively, amongst six neuro-oncology departments. Inclusion criteria were as follows: (i) history of brain radiotherapy (completed at least 6 months before the acute episode); (ii) new onset of acute/subacute neurological symptoms; (iii) exclusion of all etiologies unrelated to brain irradiation. A review of current literature on stroke-like syndromes was performed to corroborate our findings.RESULTS: Thirty-two patients with acute neurological conditions attributed to the delayed effects of radiation were identified, including 26 patients with stroke-like syndromes. Patients with stroke-like syndromes commonly presented with a mosaic of symptoms, including focal deficits (77%), encephalopathy (50%), seizures (35%) and headache (35%). Seventy-three percent of them had acute consistent magnetic resonance imaging alterations. Treatment included high-dose steroids in 65% of cases. Twenty-two patients recovered completely (85%). Sixteen patients (62%) experienced relapses (median follow-up 3.5 years). A literature review identified 87 additional stroke-like cases with similar characteristics.CONCLUSIONS: Stroke-like events related to brain irradiation may be associated with permanent sequelae. Steroids are often administered on empirical grounds, as they are thought to accelerate recovery. Relapses are common, highlighting the need to elaborate adequate prevention strategies.

AB - BACKGROUND AND PURPOSE: Patients with a history of brain radiotherapy can experience acute stroke-like syndromes related to the delayed effects of brain radiation, including stroke-like migraine attacks after radiation therapy syndrome, peri-ictal pseudoprogression and acute late-onset encephalopathy after radiation therapy syndrome. The aim of this study was to collect evidence on the long-term outcome and treatment of these conditions, whose knowledge is undermined by their rarity and fragmented description.METHODS: Cases were collected, both prospectively and retrospectively, amongst six neuro-oncology departments. Inclusion criteria were as follows: (i) history of brain radiotherapy (completed at least 6 months before the acute episode); (ii) new onset of acute/subacute neurological symptoms; (iii) exclusion of all etiologies unrelated to brain irradiation. A review of current literature on stroke-like syndromes was performed to corroborate our findings.RESULTS: Thirty-two patients with acute neurological conditions attributed to the delayed effects of radiation were identified, including 26 patients with stroke-like syndromes. Patients with stroke-like syndromes commonly presented with a mosaic of symptoms, including focal deficits (77%), encephalopathy (50%), seizures (35%) and headache (35%). Seventy-three percent of them had acute consistent magnetic resonance imaging alterations. Treatment included high-dose steroids in 65% of cases. Twenty-two patients recovered completely (85%). Sixteen patients (62%) experienced relapses (median follow-up 3.5 years). A literature review identified 87 additional stroke-like cases with similar characteristics.CONCLUSIONS: Stroke-like events related to brain irradiation may be associated with permanent sequelae. Steroids are often administered on empirical grounds, as they are thought to accelerate recovery. Relapses are common, highlighting the need to elaborate adequate prevention strategies.

U2 - 10.1111/ene.13870

DO - 10.1111/ene.13870

M3 - Article

C2 - 30471162

VL - 26

SP - 639

EP - 650

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

IS - 4

ER -