Cerebral radiation necrosis and radiation induced optic neuropathy
Presentation
Had radiotherapy for a nasopharyngeal carcinoma 5 years ago, presented with headaches, memory disturbance as well as left visual and hearing loss.
Patient Data
Both temporal lobes, as well as the basal frontal lobes, show an abnormal high signal intensity on FLAIR and T2WI with heterogeneous enhancement involving both grey and white matter. The left optic nerve shows an abnormal high signal intensity on T2WI and enhancement, highly suggestive of radiation-induced optic neuropathy. Signs of bilateral mastoiditis which could be also radio-induced.
No soft tissue mass or abnormal enhancement within the nasopharynx. No cervical lymphadenopathy is seen.
An increased bone marrow signal intensity on T1WI is noted, involving the skull base, as well as the upper cervical vertebrae, maxilla, and mandible indicating a radiation-induced fatty replacement of bone marrow.
Case Discussion
MRI features highly suggestive of a cerebral radiation necrosis with a radiation-induced optic neuropathy as well as a fatty replacement of bone marrow.
Radiation-induced optic neuropathy is considered as a common and severe ocular complication following external beam radiation therapy for nasopharyngeal carcinoma. It occurs as a result of a radiation necrosis involving the anterior visual pathway.
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