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뇌전체방사선요법과 연관된 진행백질뇌병증과 뇌위축

Whole Brain Radiation Therapy Associated Diffuse Progressive Leukoencephalopathy and Brain Atrophy

Article information

J Korean Neurol Assoc. 2017;35(3):189-190
Publication date (electronic) : August 1, 2017
doi : http://dx.doi.org/10.17340/jkna.2017.3.19
Byeong-suk Kim, MD, Jin-Hee Kim, MD, Yun-Ha Hwang, MD, Taewon Kim, MD, PhD
Department of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
김병석, 김진희, 황윤하, 김태원
가톨릭대학교 의과대학 인천성모병원 신경과
Address for correspondence: Taewon Kim, MD, PhD  Department of Neurology, Incheon St. Mary’s Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea  Tel: +82-32-280-5010 Fax: +82-32-280-5244 E-mail: kimtaewon@catholic.ac.kr
received : May 6, 2017 , rev-recd : May 28, 2017 , accepted : May 28, 2017 .

58세 여성이 6개월 전부터 서서히 진행한 혼동, 기면과 보행장애로 병원에 왔다. 환자는 16개월 전 폐암의 뇌전이 때문에 좌측 측두엽에 위치한 전이종양 제거 수술과 함께 뇌 전체방사선요법(2주 동안 30 Gy in 10 fractions)을 받은 병력이 있었다(Fig. 1). 신체검사에서 시간, 장소 및 사람에 대한 지남력장애, 사지에서 운동 완만 및 경축의 파킨슨증을 보였다. 방사선요법 시행 전, 시행 후 2, 9, 16개월째 시행한 뇌자기공명영상에서 뇌실주위의 백질뇌병증과 뇌위축이 점차로 진행하는 소견이 관찰되었다(Fig. 2A-D). 이 기간 동안 환자의 인지기능장애 및 파킨슨증도 점차 진행하여 나중에는 의미 있는 단어를 거의 말하지 못하였으며 침상에서 일어나지 못하는 상태로 악화되었다. 뇌에서의 지연방사선독성은 방사선요법 후 수개월에서 수년 후에 나타난다[1]. 국소방사선요법일 경우 국소 괴사로 나타나고, 이 환자처럼 뇌전체방사선요법일 경우는 광범위백질뇌병증 및 뇌위축으로 나타난다고 알려져 있으며, 두 경우 모두 비가역적이며 예후가 불량하다[2].

Figure 1.

Gadolinum-enhanced T1-weighted brain MRI reveals a metastatic brain tumor demonstrated as a low signal mass with rim enhancement in left temporal lobe (arrow). MRI; magnetic resonance imaging.

Figure 2.

Axial FLAIR brain MRI shows progressive leukoencephalopathy (arrow) with cortical atrophy (arrowhead). These findings were not obvious on the initial brain image just before the WBRT (A), but first detected 2 months after the completion of WBRT (B; grade I by Fazekas white matter hyperintensity scale score) and progressively aggravated on the follow-up MRI (C, D; Fazekas grade 3). FLAIR; fluid-attenuated inversion recovery imaging, MRI; magnetic resonance imaging, WBRT; whole brain radiation therapy.

References

1. Rimkus Cde M, Andrade CS, Leite Cda C, McKinney AM, Lucato LT. Toxic leukoencephalopathies, including drug, medication, environmental, and radiation-induced encephalopathic syndromes. Semin Ultrasound CT MR 2014;35:97–117.
2. DeAngelis LM, Delattre JY, Posner JB. Radiation-induced dementia in patients cured of brain metastases. Neurology 1989;39:789–796.

Article information Continued

Copyright © 2017 Korean Neurological Association

Figure 1.

Figure 1.

Gadolinum-enhanced T1-weighted brain MRI reveals a metastatic brain tumor demonstrated as a low signal mass with rim enhancement in left temporal lobe (arrow). MRI; magnetic resonance imaging.

Figure 2.

Figure 2.

Axial FLAIR brain MRI shows progressive leukoencephalopathy (arrow) with cortical atrophy (arrowhead). These findings were not obvious on the initial brain image just before the WBRT (A), but first detected 2 months after the completion of WBRT (B; grade I by Fazekas white matter hyperintensity scale score) and progressively aggravated on the follow-up MRI (C, D; Fazekas grade 3). FLAIR; fluid-attenuated inversion recovery imaging, MRI; magnetic resonance imaging, WBRT; whole brain radiation therapy.