The latent period in clinical radiation myelopathy

Schultheiss, Timothy E.; Higgins, E. M.; El‐Mahdi, Anas M.

doi:10.1016/0360-3016(84)90184-6

Cited by 120 publications

(32 citation statements)

References 40 publications

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“…[3][4][5][6][7][8][9][10][11] One of them is demyelination (mainly related to the loss of oligodendrocytes and glial progenitor cells), which causes consecutive axonal loss, gliosis and astrocytosis (Type 1 lesion). Vascular (Type 2) lesions include endothelial cell damage in all vessels, preferentially in arterioles and venules, 11 but also in capillaries, accompanied by a chronic inflammatory reaction involving mononuclears (lymphocytes, mainly T cells, macrophages and microglia) and often fibrinoid necrosis of the vascular wall (radiation vasculitis).…”

Section: Discussionmentioning

confidence: 99%

“…This rare complication of radiotherapy can affect the white and grey matter structures separately or in combination. [3][4][5][6][7][8][9][10][11] The clinical picture of predominantly white matter injury (demyelination and vascular injury) consists of spastic motor sequelae, and sensory and vegetative deficits. Radiation myelopathy may also manifest itself less frequently as grey matter damage, that is, the destruction of neurones.…”

Section: Introductionmentioning

confidence: 99%

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Autopsy verifies demyelination and lack of vascular damage in partially reversible radiation myelopathy

Lengyel

Rékó²,

Majtenyi³

et al. 2003

Spinal Cord

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Study design: Case report of recovering radiation myelopathy. Objective: To present autopsy and functional imaging findings on a unique case of slowly recovering radiation myelopathy with the aim of the clarification of the underlying mechanism. Patient: The cervical spinal cord and the distal part of the medulla oblongata of a 36-year-old thyroid cancer patient had been incorrectly irradiated with a total dose of 61 Gy and a fraction size of 3.4 Gy (J Neurol Sci 1999; 163:39-43), resulting in incomplete cervical transection with a 5-month latency period following the termination of radiotherapy. This was followed by a 9.5-year spontaneous improvement until her demise, during which the check-ups were supplemented by positron emission tomography (PET) investigations; these indicated increased Results: Autopsy revealed demyelination (with axonal loss) and neuronal damage in the cervical spinal cord and the distal part of the medulla oblongata. In the same region, only minimal vascular injury (thickening of some of the capillary walls) was detected, but not cell proliferation or chronic inflammation. Bilateral, secondary pyramidal tract degeneration caudal to the irradiated segment was observed. The PET and autopsy findings, although separated by 2 years, are consistent. Conclusions: The pathological state of the spinal cord revealed by the autopsy is concordant with the incomplete cervical transection, implying that the functional recovery is supported by a process that probably differs from the restoration of the mechanism destroyed by the radiotherapy. For the restoration of the function, we suggest an altered conduction mechanism of the action potential, involving an increased number of sodium channels along the demyelinated segments of the injured axons, which is fully congruent with the PET findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autopsy verifies demyelination and lack of vascular damage in partially reversible radiation myelopathy

Lengyel

Rékó²,

Majtenyi³

et al. 2003

Spinal Cord

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“…The threshold for spinal cord toxicity is approximately 45 to 50 Gy (Bouffet et al, 1997;Hopewell, 1998;Linstadt et al, 1989). This is based on the concept that the still developing spinal cords of children have a tolerance that is 10% to 15% lower than in adults, resulting in a greater susceptibility to radiationinduced myelopathy (Constantini et al, 1996;Reimer and Onofrio, 1985;Schultheiss et al, 1984). The tolerance of the spinal cord may be further diminished by the presence of in ltrating tumor (Linstadt et al, 1989).…”

Section: Discussionmentioning

confidence: 99%

Carboplatin chemotherapy for progressive intramedullary spinal cord low-grade gliomas in children: Three case studies and a review of the literature

Hassall¹,

Mitchell²,

Ashley³

2001

Neuro-Oncol

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“…If compared to TRM, the onset is usually delayed. It occurs within 9 to 15 months after radiotherapy is completed but it was reported as early as I month or as late as 6 years after treatment [24]. The first symptoms are represented by paresthesia and loss of temperature and pain sensation.…”

Section: Discussionmentioning

confidence: 99%