Diagnosis of delayed cerebral radiation necrosis following proton beam therapy
M. Kaufman, B. E. Swartz, M. Mandelkern, J. Ropchan, M. Gee and W. H. Blahd
Department of Neurology, Wadsworth Veterans Administration Medical Center, Los Angeles, Calif. 90073.
A 27-year-old man developed delayed cerebral radiation necrosis following
proton beam therapy to an arteriovenous malformation. Neuroimaging with
technetium 99m diethylenetriamine penta-acetic acid and positron emission
tomographic scanning with fludeoxyglucose F 18 aided in his evaluation.
Significant improvement of his neurologic deficits resulted from
corticosteroid therapy. Clinical resolution was corroborated by serial
computed tomographic scans demonstrating regression of the abnormality (a
mass lesion). Various facets of radiation injury are discussed, including
pathogenesis, risk factors, diagnosis, and therapy.