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British Journal of Radiology (2006) 79, e196-e199
© 2006 British Institute of Radiology
doi: 10.1259/bjr/50789043
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Case report

Significant response of radiation induced CNS toxicity to high dose steroid administration

M Genc, MD1, E Genc, MD2, B O Genc, MD2 and D A Kiresi, MD3

Departments of 1 Radiation Oncology, 2 Neurology and 3 Radiology, Meram Medical Faculty, Selcuk University, Konya, Turkey

Correspondence: Dr Mine Genc, Department of Radiation Oncology, Selcuk University, Meram Medical Faculty, 42080, Akyokus, Konya, Turkey. E-mail: minegenc{at}yahoo.com

Treatment of radiation myelopathy remains a challenge. Supportive and rehabilitative therapy is the mainstay of treatment. This article describes a case of central nervous system (CNS) toxicity of radiation with a progressive improvement in the clinicoradiological picture following high dose steroid treatment. A female patient was admitted to the neurology department of our hospital 7 months after a course of radiotherapy in another centre for lingual epidermoid cancer. Neurological examination revealed a heavy spastic quadriplegia syndrome. On MRI examination, T2 weighted hyperintensities were observed in cerebral and cerebellar peduncles, periventricular regions and medulla spinalis at Th1-Th2 levels. The patient was treated with high dose methylprednisolone, 1 g day–1 for 5 days (pulse therapy) followed by oral methylprednisolone 80 mg day–1 for a week, tapered over 3 weeks. Within the first week of pulse therapy, she regained muscle strength of upper limbs against gravity. At the 2 year follow-up, MRI demonstrated obvious regression of the lesions in the medulla and cerebellum with disappearance of contrast enhancement. This case report is notable with the complete disappearance of MRI lesions at the 2 year follow-up after the treatment with high dose steroid.






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