Learning objectives
- What is Radiation Vascuopalthy
- Recognition of Radiation Vascuopalthy
- Treatment of Radiation Vascuopalthy
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Introduction
- Stroke can complicate head and neck radiotherapy and result in TIA/Stroke disease
Introduction
- Occlusive radiation vasculopathy is is marked by its delayed presentation years after treatment
- Children and adults develop netlike vessels and transdural anastomoses which can mimic moyamoya disease
- In the past patients died of their malignancy but less so now and they live long enough to develop strokes
Tumours needing Radiation therapy
- Squamous cell carcinoma of the head and neck
- Lymphoma and breast cancer were the main tumour types targeted by neck XRT
- Pituitary tumours in adults and optic pathway gliomas in children
- Nasopharyngeal carcinoma, in which both carotids are typically involved in the field
Clinical
- Clinical syndromes related to ischaemic stroke, transient ischemic attack (TIA), or carotid stenosis
Investigations
- CT/A may show strictures and narrowing
- Carotid duplex may show narrowing
Differentials
Management
- Carotid endarterectomy is difficult as tissue is scarred and stenting may be more appropriate for severe carotid stenosis but with high restenosis rates.
References and further reading
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