Radiation-induced angiopathy in acute stroke patients

Studies investigating patients with irradiation induced stroke are rare, and the clinical presentation, imaging features, and related vascular abnormalities remain to be studied. We reviewed 12 consecutive stroke patients (8 men and 4 women; mean age = 60 years) who had a previous history of radiation therapy because of head and neck malignancies. Brain CT/MRI and angiography were performed in all the patients. All the patients presented with transient ischemic attack or completed stroke. Vascular lesions generally occurred at the areas compatible with the radiation site. Significant extracranial carotid stenosis was observed in 7 patients, and 5 of them had neck malignancies. Intracranial vascular lesions were documented in 7, which included distal vertebral and/or basilar artery in 3, and distal carotid artery and/or middle cerebral artery in 6 patients. Five of them had head malignancy. The mean interval between the irradiation and the onset of stroke was 8.5 years, which tended to be short in patients with intracranial diseases as compared to those with extracranial diseases. We conclude that intracranial arterial diseases are at least as frequent as extracranial diseases in patients with radiation-induced stroke. This potential hazard of radiotherapy should be considered in treating patients with head and neck malignancy.