鼻咽癌术后放疗致放射性脑病1例报告并文献复习

目的探讨放射性脑病(REP)的临床、影像学特点、诊断与鉴别诊断和治疗方法,以及发病机制。方法回顾性分析1例放射性脑病患者的临床资料,包括临床症状、影像学表现、治疗经过及预后;并对相关文献进行复习。结果患者既往有鼻咽癌及放射治疗史;临床表现为癫痫失神发作;MRI示右侧颞叶类圆形病变,周围大片水肿;经手术切除病变及术后糖皮质激素、脱水、改善循环、营养神经药物治疗,病情明显改善;术后病理检查证实为放射性脑病。结论放射性脑病的临床和影像学表现无特异性,常易与脑胶质瘤等相混淆,确诊须依靠病史及病理检查;药物治疗效果不明显或高颅压症状明显时,应行手术切除病变。

Radiation encephalopathy after postoperative radiotherapy for nasopharyngeal carcinoma(a case report and literature review)

Objective To review the pathogenesis,clinical characteristics,diagnosis,differential diagnosis and treatment of radiation encephalopathy(REP).Methods The clinical data of 1 case of REP were analyzed retrospectively,including clinical symptoms,imaging manifestations,treatment process and prognosis,and the related literature was reviewed.Results The patient had a history of nasopharyngeal cancer and radiotherapy.The clinical manifestations were epileptic absence seizure.MRI showed a round lesion in the right temporal lobe with large edema surrounding it.After surgical excision of the lesion and postoperative glucocorticoid,dehydration,improvement of circulation and nutritional nerve drug treatment,the condition was significantly improved.Postoperative pathological examination confirmed radioactive encephalopathy.Conclusions The clinical and imaging manifestations of REP are nonspecific and often confused with glioma.The diagnosis depends on the history and pathological examination.When the effect of drug treatment is not obvious or the symptoms of high intracranial pressure are obvious,the lesion should be removed by surgery.