Abstract TP230: Small Vessel Infarction as a Late Complication of Cranial Irradiation

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Background and Purpose: Small vessel infarction after cranial irradiation is rare manifestation, whereas large vessel disease is well-known as a late complication. The purpose of this study is to investigate the clinical features of the small vessel infarction associated with the previous cranial irradiation.

Patients and Methods: This is a retrospective chart review study of the patients presenting with small vessel infarction after cranial irradiation, retrieved from the single center database between 1998 and 2015. We reviewed the clinical characteristics, types and doses of irradiation, interval between first irradiation and first stroke, radiographic findings of the infarctions, and clinical courses.

Results: Thirteen cases were identified, 12 men, 54 +/- 14 years of age at stroke onset. Underlying diseases for irradiation were 8 primary brain tumor, 4 metastatic brain tumor, 1 Leukemia, and 1 histologically undetermined brain tumor. Irradiation methods were 9 whole brain irradiation, 2 intensity modulated radiation therapy, and 2 local irradiation. Mean dose of irradiation was 51 +/- 10 Gy. Infarcted lesions were 8 corona radiata, 5 posterior limb of internal capsule, 1 thalamus. Mean time from first irradiation to first stroke was 14 +/- 14 years. Median NIHSS score at onset was 4 (min-max: 1-11), and median modified Rankin Scale at discharge was 3 (min-max: 1-4). One case had recurrence of infarction in the different territory of perforating artery, and one case had exacerbation due to infarction growth.

Conclusions: Vasculopathy after irradiation also occurs in perforating arteries as well as in large vessels. Irradiation induced small vessel vasculopathy should be recognized as an important cause of stroke among brain tumor survivor.

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