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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(03): 199-200
DOI: 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 Júnior
1   Universidade Federal do Espírito Santo, Departamento de Radiologia, Vitória ES, Brasil;
2   BRAEN, Laboratório de Pesquisa em Neurorradiologia, Vitória ES, Brasil;
,
Antçnio José da Rocha
3   Santa Casa de Misericórdia de São Paulo, Seção de Neurorradiologia, São Paulo SP, Brasil.
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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]).

Zoom Image
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.
Zoom Image
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 spaces[1],[2],[3],[4].


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Conflict of interest:

There is no conflict of interest to declare.

  • 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/s00234-014-1356-9
  • 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)00031-2
  • 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.2393050823
  • 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.A3669

Address for correspondence

Marcos Rosa Júnior
Universidade Federal do Espírito Santo – UFES, Centro de Ciências da Saúde; Av Marechal Campos, 1468; 29043-900 Vitória ES
Brasil   

Publication History

Received: 18 August 2016

Accepted: 31 December 2016

Article published online:
05 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • 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/s00234-014-1356-9
  • 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)00031-2
  • 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.2393050823
  • 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.A3669

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