Cerebral Radiation Necrosis Masquerading as Recurrent, High-Grade Meningioma: A Case Report

Abstract

Background: Cerebral radiation necrosis (CRN) is a complication caused by radiation therapy (RT) used for treating high-grade intracranial neoplasms. It is essential to be aware of this condition as it can be frequently mistaken for tumor recurrence. Herein, we report a case of misdiagnosis of CRN in a young male, which has heavily influenced his clinical history.Case Presentation: We report a 25-year-old male diagnosed with right frontal convexity meningioma based on computerized tomography (CT)/magnetic resonance imaging (MRI). The operation achieved a macroscopically complete tumor resection. The histopathology was an atypical meningioma. Accordingly, the patient received RT. The patient reported new-onset of generalized seizures and worsening of left hemiparesis three months after completion of RT. MRI showed abnormal peripheral enhancement in the right frontal region involving the genu of the corpus callosum and extensive brain edema. Magnetic resonance spectrometry (MRS) changes were suggestive of tumor recurrence. The patient underwent surgery with total resection of the lesion. The histopathology was CRN without evidence of tumor recurrence. Due to refractory progressive brain edema, the patient’s clinical status deteriorated until he expired.Conclusion: CRN carries morbidity and mortality as a complication from brain irradiation. There is no single modality that can reliably distinguish CRN from recurrent tumor. Therefore, a multimodality approach highly recommended.