A 15-Year-Old Girl With Sudden Onsent Reversible Neurologic Symptoms After Cranial Irradiation for Medulloblastoma

Reversible Cerebral Vasoconstriction Syndrome Associated with a Suprarenal Mass

“…By the time of the reporting of this case, there have been no cases of RCVS associated with suprarenal adenoma published. Although tumours may favour the appearance of RCVS, it has also been described that surgical and non-surgical oncologic treatment may induce vascular changes at the brain level that lead to the disease (Mathis et al, 2017;Duke et al, 2018;Katada et al, 2018). In the case of radiotherapy, particularly in brain tumours, it can lead to dynamic vascular lesions and generate pathologies such as RCVS, SMART syndrome (stroke-like migraine attacks after radiation therapy), Moya-Moya disease or even haemorrhagic cerebrovascular attack (Duke et al, 2018;Katada et al, 2018).…”

“…Although tumours may favour the appearance of RCVS, it has also been described that surgical and non-surgical oncologic treatment may induce vascular changes at the brain level that lead to the disease (Mathis et al, 2017;Duke et al, 2018;Katada et al, 2018). In the case of radiotherapy, particularly in brain tumours, it can lead to dynamic vascular lesions and generate pathologies such as RCVS, SMART syndrome (stroke-like migraine attacks after radiation therapy), Moya-Moya disease or even haemorrhagic cerebrovascular attack (Duke et al, 2018;Katada et al, 2018). Similarly, there is an association between treatment with chemotherapy and the appearance of vasospasm at the cerebral level, as is the case of the chemotherapy regimen with oxaliplatin and capecitabine, which has been linked as an aetiology of subsequent reversible leukoencephalopathy syndrome presented with RCVS in up to 38% of cases (Mathis et al, 2017;Duke et al, 2018;Katada et al, 2018).…”

“…Cases have been described in the literature with producing and non-producing masses of metanephrines (Mori et al, 2012;Duke and Ullrich, 2018;Katada et al, 2018;Arenas-Beltrán et al, 2019). Within these reports, associations with cavernous haemangioma, medulloblastoma, colon cancer, paraganglioma, pheochromocytoma, uterine fibroids, among others were found (Mori et al, 2012;Duke et al, 2018;Katada et al, 2018;Arenas-Beltrán et al, 2019). However, no association with adrenal masses which do not produce metanephrines was found.…”

Stroke-Like Migraine Attacks after Radiation Therapy Syndrome: Clinical and Imaging Characteristics

“…SMART syndrome is a rare neurologic complication that appears months to years after radiotherapy of intracranial neoplasms with unilateral headache and possibly along with other symptoms such as nausea, vomiting, hemiparesis, and seizures. [6] Although the pathophysiology of SMART syndrome is not clearly understood, radiation-induced damage of endothelial cells is proposed to be the initial insult,[7] with some considering the pathogenesis similar to posterior reversible encephalopathy syndrome (PRES) due to the insult leading to blood–brain barrier malfunction seen with some vasculopathies. [8] SMART syndrome is usually self-limited; therefore, invasive testing such as angiography or biopsy is not recommended and may even be harmful.…”

“…The radiologic hallmark of SMART syndrome is increased T2 hyperintensity in the previously radiated location and gyral enhancement in the same region evident within 1 week of neurological symptoms. [7]…”