A CASE OF JUVENILE STROKE CAUSED BY ACTINIC CERVICAL ARTERIOPATHY

Abstract

Introduction: Radiation Arteriopathy is a vascular disease characterized by progressive arterial stenosis that may occur after external radiotherapy (RT) directed to a specific body region affected by malignant tumours. The arterial damage usually starts many years after the injury and the specific pathogenesis is unknown, though atherosclerosis praecox, endothelial damage, adventitial fibrosis and vasa vasorum obliteration are likely involved mechanisms. In patients with previously irradiated neck or head cancers, supra aortic arteries can be affected in their segments exposed to radiations leading to a gradual lumen narrowing. This late complication leads to a progressive stenosis of extracranial cerebral arteries and consequently an increased risk of stroke. Case Report: A 29-years-old man was admitted to our Neurology ward due to a sudden onset of focal neurological impairment. He was heavy smoker and drunk alcohol moderately, also he experienced similar symptoms previously. MRI imaging showed a recent ischemic lesion in the middle cerebral artery territory and other previous ischemic events. A CT-angiography of the extracranial cerebral arteries confirmed a diffuse non focal narrowing of several cerebro-afferent vessels. More clinical and instrumental investigations ruled out any involvement on different other vascular districts. A relevant information to establish the diagnosis was a history of nasopharyngeal carcinoma treated with Radiotherapy at age of 16 year-old, after other possible causes of juvenile stroke have been excluded. Conclusion: Patients who have been treated with Radiotherapy because of head or neck cancers represent a high risk population of developing a severe arteriopathy of the main extracranial arteries leading to recurrent stroke, even at a young age. Therefore, we propose a long-term follow-up of this population and further studies in order to establish the best treatment.