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Reversible, strokelike migraine attacks in patients with previous radiation therapy
J D Bartleson1, Karl N Krecke, Brian P O'Neill
1Departments of Neurology, Mayo Clinic, Rochester, MN 55905, USA. bartleson.john@mayo.edu
Neuro-Oncology
|April 4, 2003
Summary
Radiation therapy for head cancers may lead to prolonged, stroke-like migraine attacks years later. These episodes involve reversible neurological deficits and transient brain MRI changes, suggesting a link to radiation-induced vascular issues.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Two adult patients with a history of head radiation therapy for malignancy developed unusual neurological episodes.
- One patient had B-cell lymphoma, the other had multiple hemangioendotheliomas, both treated with radiation years prior.
Observation:
- Patients experienced prolonged, reversible neurological deficits associated with headache, resembling migraine with or without aura.
- Episodes included occasional seizures and striking, transient cortical gadolinium enhancement on MRI, particularly in posterior cerebral gyri.
- Neurologic deficits progressed over days, lasted weeks, and fully resolved without epileptiform activity on EEG.
Findings:
- Interictal MRI scans revealed stable abnormalities consistent with prior radiation therapy.
- No residual tumor, recurrent malignancy, or other recognized cause for the episodes was identified.
- A potential causal relationship between remote radiation therapy and these prolonged, strokelike migraine attacks is postulated.
Implications:
- Radiation-induced vascular changes are proposed as a mechanism for provoking these prolonged migraine attacks.
- This syndrome may occur with or without an underlying migraine predisposition.
- Recognizing this association can help clinicians avoid unnecessary invasive diagnostic procedures.