Radiation-induced spinal nerve root cavernous malformations as a rare cause of radiculopathy

A 48-year-old man with Hodgkin lymphoma presented with insidious painless asymmetric ankle then thigh weakness 16 years after mantle-field radiation. EMG was consistent with a motor lumbosacral polyradiculopathy. CSF had 15 white blood cells/μL, protein 387 mg/dL, and normal glucose. Nodular enhancing lesions were seen on lumbar MRI (figure 1). Caudal root biopsy demonstrated mulberry-shaped vascular abnormalities (figure 2) and thickened endoneurial vessel walls without inflammation. Workup for leptomeningeal carcinomatosis and inflammatory and infectious disease was negative. High-dose steroids produced no clinical improvement. A diagnosis of radiation-induced cavernous malformations, a rare complication of radiation previously reported in the cauda equina, was made.1,2
Source: Neurology - Category: Neurology Authors: Tags: MRI, All Clinical Neurology, All Neuromuscular Disease, All Oncology, All Spinal Cord NEUROIMAGES Source Type: research