Neurological complications of radiation therapy: a clinical case of post-radiation myelopathy

Background. Radiation therapy is one of the main methods of treatment of primary and secondary malignancies of the central nervous system. Radiation myelopathy is a rare but potentially devastating complication of radiation exposure, which causes pain, paresthesia, numbness, paralysis, Brown–Séquard syndrome, bowel/bladder incontinence, and is defined as a neurological sensory or motor deficit caused by radiation therapy in the absence of tumor progression. Purpose – to spread information among the medical community about the neurological complications of radiation therapy of malignant neoplasms of the central nervous system using the example of a clinical case of post-radiation myelopathy. Materials and methods. Clinical observation of patient S., 72 years old, who underwent examination and inpatient treatment at the Department of Radiation Pathology and Palliative Care of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine». Results. In this clinical case, the patient had breast cancer, which progressed 6 years after the diagnosis and treatment in the form of a metastatic lesion of the spine, therefore she received a course of radiation therapy to the area of the 12th thoracic vertebra. After 11 months, she developed subacute focal neurological symptoms of the spinal cord issues in the form of a complete transverse lesion and the most pronounced abnormalities of the posterior columns in the form of complete anesthesia of deep sensitivity, which corresponded to the foci detected during the MRI examination and coincided with the area of irradiation. This made it possible to consider these clinical manifestations as delayed post-radiation myelopathy. Conclusions. Post-radiation myelopathy is a fairly rare but severe complication of the central nervous system with an unpredictable course. Treatment for radiation myelopathy may include steroids, pentoxifylline, and hyperbaric oxygenation, but unfortunately, evidence of the effectiveness of these treatment methods to eliminate the consequences of radiation damage is not high.