[Late post-irradiation cervical spinal cord disease. A case]

Abstract

A case of delayed progressive radiation myelitis (DPRM) which begin 11 months after naso pharyngeal carcinoma radiation, in a young man, is reported. The initial manifestation is often a Brown-Sequard's syndrome progressing to complete and permanent myelopathy, with notable absence of localized or radicular pain. The parenchymal change of the spinal cord in radiation myelopathy can be easily visualized with magnetic resonance imaging (MRI) however there may be cases in which MRI appearance alone does not distinguish specially between tumor and radiation necrosis with absolute confidence: therefore, DPRM is by necessity a diagnosis of exclusion, based on clinical, paraclinical results and course of disease. Corticosteroid therapy is accompanied by a significant remission of symptoms. The evolution is characterized by a worse prognosis, prevention is absolutely necessary based on perfect radiation technic, knowledge on tolerance of spinal cord to irradiation (time-dose-volume factors) and other risks factors (chemotherapy, age and vascular disease).