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Delayed brain hemorrhage associated with prophylactic whole brain irradiation for pediatric malignant brain tumor: a
1Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Japan.
Insights
Delayed radiation effects can cause brain hemorrhages in children. This case highlights the risk of repeated intraparenchymal hemorrhage years after pediatric brain tumor irradiation.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neurology
Background:
- A 7-year-old girl with a history of undifferentiated brain stem glioma underwent partial tumor removal.
- The patient received craniospinal (30 Gy) and posterior fossa booster (20 Gy) irradiation at 20 months of age.
Observation:
- The patient presented with sudden onset intraparenchymal hemorrhage in the left frontal lobe.
- Follow-up neuro-imaging at age 9 years revealed two additional small, occult hemorrhages (chronic and subacute).
Findings:
- The intraparenchymal hemorrhage was suspected to be a delayed effect of prior radiation therapy.
- The occurrence of multiple hemorrhages suggests a potential for repeated delayed radiation-induced vascular injury.
Implications:
- This case underscores the importance of considering delayed radiation effects in the long-term management of pediatric brain tumor survivors.
- Neuro-imaging surveillance may be warranted to detect potential vascular complications following pediatric brain irradiation.
- Further research into the mechanisms of delayed radiation-induced vascular damage is crucial for improving treatment protocols and patient outcomes.
Abstract:
Intraparenchymal hemorrhage in the left frontal lobe suddenly occurred in a 7-year-old girl who had undergone partial removal of an undifferentiated brain stem glioma and received craniospinal (30 Gy) and posterior fossa booster (20 Gy) irradiation at the age of 20 months. The brain hemorrhage was thought to be delayed irradiation effect. Follow-up neuro-imaging at age 9 years showed two more small occult chronic and subacute hemorrhages in the brain. The possibility of repeated hemorrhage as a delayed reaction to brain irradiation is emphasized.