Neurologic Complications After Irradiation of Malignant Tumors of the Testis

Radiation-induced injury to nerve tissue unavoidably included in the irradiated areas during treatment of malignant tumors has been reported for both the peripheral (STOLL & ANDREWS 1966, SPIESS 1972) and the central nervous system.Several clinical syndromes have been distinguished in connection with the lesions arising after irradiation of the cervicothoracic spinal cord.Transient radiation myelopathy (JONES 1964, BEKMARK 1975) constitutes one group, with purely subjective symptoms in the form of paresthesias, often Lhermitte's sign, which disappear spontaneously within a few months.Another group is marked by irreversible, partial or complete transverse medullary lesions with spastic paresis, loss of sensibility, and bladder and rectum dysfunction.On the basis of the course, cases of acute radiation myelopathy have been described ( BODEN 1948, PALLIS et coll.1961), in which the symptoms reached their peak within a few days.However, such an acute course is rare; in most cases it is a question of a chronic progressive myelopathy developing over a period of months or years (REAGAN et COIL 1968, PALMER 1972).In connection with irradiation of the lumbar spine in the treatment of malignant testicular tumors GREENFIELD & STARK (1 948) used the designation postirradiation neuropathy to describe a syndrome with flaccid paresis in the lower extremities but without sensibility disturbance, and suggested that this could be the result of selective injury to anterior horn cells.Judging from the literature, this syndrome is uncommon.Fifteen such cases have been described (MAIER et coll.1969).Several authors have attempted to establish tolerance limits for the spinal cord at