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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282XOn-line version ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.75 no.3 São Paulo Mar. 2017

http://dx.doi.org/10.1590/0004-282x20160196 

IMAGES IN NEUROLOGY

Late radiation therapy brain abnormalities that mimic leukoencephalopathy with anterior temporal lobe cysts

Alterações encefálicas tardias pós radioterapia mimetizando leucoencefalopatia com cistos temporais anteriores

Marcos Rosa Júnior1  2 

Antônio José da Rocha3 

1Universidade Federal do Espírito Santo, Departamento de Radiologia, Vitória ES, Brasil;

2BRAEN, Laboratório de Pesquisa em Neurorradiologia, Vitória ES, Brasil;

3Santa Casa de Misericórdia de São Paulo, Seção de Neurorradiologia, São Paulo SP, Brasil.

A 43-year-old man who had been treated for a craniopharyngioma with surgery and radiotherapy (33 years ago) was referred for evaluation of a sudden hemiparesis. Neuroimaging documented a brainstem cavernoma associated with basal ganglia calcifications and white matter hyperintensity near anterior temporal lobe cysts (Figures 1 and 2).

Figure 1 Axial GRE (A) and T1 GD (B) showed a focal hemorrhage compatible with a radiation-induced cavernoma in the brainstem. Axial FLAIR (C) showed white matter hyperintensity around anterior temporal lobe cysts. 

Figure 2 Axial non-contrast CT confirmed a hemorrhagic lesion in the brainstem (A) and basal ganglia calcifications (B). 

Late brain abnormalities are often observed after radiotherapy for childhood intracranial tumors. Microbleeds and cavernomas are well recognized in these cases. However, bilateral anterior temporal lobe cysts are uncommon, and it is crucial to recognize these to avoid misdiagnoses, particularly when they are associated with white matter abnormalities. Differential diagnoses include hereditary disorders, infectious diseases, and dilated perivascular spaces1,2,3,4.

References

1. Nunes RH, Pacheco FT, Rocha AJ. Magnetic resonance imaging of anterior temporal lobe cysts in children: discriminating special imaging features in a particular group of diseases. Neuroradiology. 2014;56(7):569-77. https://doi.org/10.1007/s00234-014-1356-9Links ]

2. Cross NE, Glantz MJ. Neurologic complications of radiation therapy. Neurol Clin N Am. 2003;21(1):249-77. https://doi.org/10.1016/S0733-8619(02)00031-2Links ]

3. Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology. 2006;239(3):650-4. https://doi.org/10.1148/radiol.2393050823Links ]

4. Rawal S, Croul SE, Willinsky RA, Tymianski M, Krings T. Subcortical cystic lesions within the anterior superior temporal gyrus: a newly recognized characteristic location for dilated perivascular spaces. AJNR Am J Neuroradiol. 2014;35(2):317-22. https://doi.org/10.3174/ajnr.A3669Links ]

Received: August 18, 2016; Accepted: December 31, 2016

Correspondence: Marcos Rosa Júnior; Universidade Federal do Espírito Santo – UFES, Centro de Ciências da Saúde; Av Marechal Campos, 1468; 29043-900 Vitória ES, Brasil; E-mail: marcosrosajr@hotmail.com

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.