[Multiple intracranial aneurysms following radiation therapy for pituitary adenoma; a case report]

A report is made here on a rare case in which occurrence of multiple cerebral aneurysm was observed after radiotherapy. The case was that of a female aged 51 who was hospitalized with the chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during the patient's hospitalization, and multiple cerebral infarction was also observed by CT scanning and MR imaging. Therefore, conservative treatments including intensified endocrine-supplementing treatment, centering on thyroid hormone, were attempted. The patient's thyroid gland function and hyperlipidemia improved but the consciousness disorder persisted. Exacerbation of the consciousness disorder occurred suddenly 6 weeks after the patient's hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifurcation of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery and irregularity of wall width in the central artery including the terminal region of the internal carotid artery. These findings were not observed at the initial hospitalization and were considered to have been formed newly afterwards. Further, these findings were observed unexceptionally in all the radiated fields. The patient died 8 weeks after hospitalization, and no autopsy finding was obtained. From the above, we presumed that radiation vasculopathy caused by the radiation therapy made one year previously, had led to the formation of multiple cerebral aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)