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Delayed radiation necrosis of a spinal nerve root presenting as an intra-spinal mass

Department of Radiology, Evanston Hospital, Northwestern University, 2650 Ridge Avenue, Evanston, Illinois 60201, USA

This excerpt was created in the absence of an abstract.

Frequently the nervous system is exposed to appreciable doses of radiation when a lesion within or in close proximity to the brain, spinal cord or peripheral nerves is the target of radiation therapy (Fischer and Holfelder, 1930; Kramer, 1968; Kramer et al., 1972; Crompton and Layton, 1961; Stevenson and Eckhardt, 1945; Dynes and Smedal, 1960). Radiation induced necrosis of the central nervous system (CNS) is a well-recognized hazard (Fischer and Holfelder, 1930; Kramer, 1968; Kramer et al., 1972; Crompton and Layton, 1961; Stevenson and Eckhardt, 1945; Dynes and Smedal, 1960). The site and extent correlates with zones of high radiation on dose reconstruction plans (Mikhael, 1978; 1979). Recognition of these post-radiation changes is important since surgical removal may significantly remove their neurological effects (Mikhael, 1978; 1979).

A 16-year-old male presented with a six-week history of progressive weakness of the arms and legs particularly on the left side. He had been treated for Hodgkin's disease (stage II–A) that presented as a left neck mass at the age of eight years. He received 4000 rad tumour dose (20 fractions over 40 days, 200 rad/day using 2 MeV X rays) (Fig. 3A). Approximately eight months later he was treated for right tonsillar recurrence. He received an additional 4000 rad tumour dose (20 fractions over 37 days using 15 MeV electron beam) to the neck area (Fig. 3B). His current complaints started seven years after the last course of therapy.

Received for publication May 1, 1979.