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Radiation Myelitis


Presentation

  • Up until the present, no tolerance dose for the spinal cord has accurately been defined and no treatment has proved satisfactory.[ncbi.nlm.nih.gov]
  • Two patients are presented who developed radiation myelitis as a complication of treatment for medulloblastoma.[ncbi.nlm.nih.gov]
  • Presents full-color images throughout to match the images that you see in practice. Extensive use of "combination" imaging presents a complete picture of how to more precisely locate and target the radiotherapy field.[books.google.com]
  • Presentation Follow up case of breast carcinoma, with vertebral metastasis at D10 level who received high-dose of radiation therapy. Presented with complaints of pain in dorsal spine and inability to walk.[radiopaedia.org]
  • Lung cancer is a common malignant disease, often with distant metastases as first presenting sign of malignant disease.[ro-journal.biomedcentral.com]
Plethora
  • On the other hand, the rapid progress in drug development, with a plethora of novel targeted drugs and a lack of basic radiobiological data on their combination with radiotherapy, has left us with questions about possible interactions each time, when[ro-journal.biomedcentral.com]
Neck Pain
  • Two months after that, he complained of severe neck pain and rapidly progressing weakness in all extremities. MRI showed an enhanced intramedullary lesion with extensive edema in the cervical spinal cord.[ncbi.nlm.nih.gov]
Limb Weakness
  • A 64-year-old male with a medical history of hypertension presented with an acute onset of urinary retention with lower limb weakness. Based on the initial MRI and evaluation, a diagnosis of acute transverse myelitis was made.[cureus.com]
  • This toxin, β-N-oxalyl-L-α,β-diaminopropionic acid, a neurotoxic amino acid, causes an acute to subacute, irreversible, nonprogressive spastic paraparesis that may be preceded by a series of symptoms including lower limb weakness, myalgia and stiffness[now.aapmr.org]

Workup

  • However, whether the cause of the acute myelopathy is inflammatory or not is not self-evident; therefore, the clinical and diagnostic workup for ATM requires that other causes of acute myelopathies be excluded.[thieme-connect.com]

Treatment

  • Hyperbaric oxygen therapy is already currently used as adjuvant treatment for osteoradionecrosis and for radionecrosis of soft tissues with satisfactory results, whereas results for the treatment of post-attinic myelitis were contradictory.[ncbi.nlm.nih.gov]
  • Two patients are presented who developed radiation myelitis as a complication of treatment for medulloblastoma.[ncbi.nlm.nih.gov]
  • We report a case of confounding radiation myelitis to demonstrate the usefulness of surgical biopsy in ensuring the correct diagnosis and to avoid unnecessary treatment.[ncbi.nlm.nih.gov]
  • It is important not to exclude other potentially helpful treatment, such as surgery or chemotherapy, by the presumptive diagnosis of radiation myelitis.[ncbi.nlm.nih.gov]

Prognosis

  • . [2] In their series, poor prognosis was present in 22.2% cases and death occurred in 5.5% cases.[neurologyindia.com]
  • Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis.[thieme-connect.com]
  • Poor prognosis was assigned to patients with inability to walk 100 m even with help and severe sensory or sphincter dysfunction.[academic.oup.com]
  • Generally, the more rapid the onset and more severe the neurologic deficits, the poorer the prognosis is for complete recovery. Extent of MRI involvement in vitamin B12 has not been shown to correlate with degree of recovery.[now.aapmr.org]
  • PS is a well known major determinant of prognosis in these patients.[cochranelibrary.com]

Etiology

  • ., systemic autoimmune disease) Can have a partial or complete effect on the spinal cord Etiology post-infectious bacteria Mycoplasma pneumoniae Campylobacter jejuni virus hepatitis A, B, C MMR EBV influenza post-vaccination demyelinating disease multiple[medbullets.com]
  • Despite thorough evaluation, the etiology of transverse myelitis was undetermined.[cureus.com]
  • The etiology of acute-onset transverse myelitis remains unknown. In 30-60% of patients there is an antecedent respiratory, gastrointestinal or systemic illness.[signavitae.com]
  • Therefore, physicians must be aware of the many potential etiologies for acute myelopathy, and should pursue an ordered, efficient, and cost-effective approach to the diagnosis based on the patient's clinical history, examination, and magnetic resonance[thieme-connect.com]
  • Despite different etiologies underlying these conditions, they tend to have many clinical, electrophysiologic, and neuropathologic similarities.[now.aapmr.org]

Epidemiology

  • Epidemiology varies with the toxins as previously described. Risk factors for toxic myelopathies are exposures to the etiologic toxin.[now.aapmr.org]
  • Clinical and epidemiologic features of Guillain-Barrè syndrome . J Infect Dis 1997 ; 176( Suppl 2 ): S92 – S98 . Google Scholar Crossref Medline ISI 2. Young, JW, Mason, DF, Taylor, BV.[neu.sagepub.com]
  • […] demyelinating disease multiple sclerosis neuromyelitis optica demylinating encephalomyelitis systemic autoimmune disease systemic lupus erythematosus Sjögren's syndrome Behçet ' s disease ankylosing spondylitis medications sulfasalazine TNF-α inhibitors Epidemiology[medbullets.com]
  • This, in turn, leads to ischemic damage to the axons and Schwann cells. [4] Epidemiology Frequency United States The frequency of radiation-induced brachial plexopathy has declined over the past 60 years and depends significantly on both the radiation[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • […] the consequences of treatment in adult cancer, such as radiation-induced brachial plexopathy, suggest that patients benefit significantly when the prevention, detection, and treatment of some of these consequences are approached systematically. [1] Pathophysiology[emedicine.medscape.com]
  • "Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon". Neurosurg Focus. 25 (5): E2. doi : 10.3171/FOC.2008.25.11.E2. PMID 18980476.[en.wikipedia.org]
  • Although the pathophysiology of the other toxic and metabolic myelopathies have not been as well described, some distinguishing factors do exist to help differentiate between the causes.[now.aapmr.org]
  • Pathophysiology and treatment for cervical flexion myelopathy. Eur Spine J. 2002; 11(3) 276-285 Brian G Weinshenker, M.D. , F.R.C.P.(C.)[thieme-connect.com]
  • The pathophysiological hypotheses of AM in SD are still a matter for discussion. The most likely hypothesis is a vascular mechanism secondary to ischaemic lesions ( Harisdangkul et al ., 1995 ).[academic.oup.com]

Prevention

  • Radiation from these treatments sometimes damages the nervous system, despite the best efforts to prevent damage.[msdmanuals.com]
  • Prevention of Seeding. Mesothelioma spreads along surgical incisions and biopsy sites. This is called seeding. Up to half of all patients have seeding after a surgical procedure.[mesotheliomaveterans.org]
  • Primary prevention consists of maintaining normative levels of key nutrients, and avoiding drugs and other toxins if possible.[now.aapmr.org]
  • Results from the English National Cancer Survivorship initiative, which includes a study on the consequences of treatment in adult cancer, such as radiation-induced brachial plexopathy, suggest that patients benefit significantly when the prevention,[emedicine.medscape.com]
  • Sylvie Delanian a Paris md is conducting studies using pentoxifyllin with some success with fibrotic prevention and has now documented fibrotic regression. It is more effective if taken with tocopheral.[cancercompass.com]

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