Cerebral radiation necrosis and brain abscess as delayed complications after carbon ion radiotherapy against nasal carcinoma

Abstract

A case of radiation induced delayed brain necrosis associated with bacterial brain abscess is reported. A 50-year-old Japanese man with adenoid cystic carcinoma underwent carbon ion radiotherapy and the cancer disappeared on MRI one year later. The MRI taken 30 months after the therapy showed white matter edema of the left temporal lobe suggesting a radiation injury. He suffered atypical trigeminal neuralgia at the V1 territory. He became delirious as Glasgow coma scale: 9 by increased intracranial pressure. He suffered aspiration pneumonia and sepsis. 6.5 years later, an emergent craniotomy was chosen for his increased intracranial pressure and aggravating neurological symptoms. Left temporal pole and necrotic tissues were removed and bacterial brain abscess was found. Brain abscess was managed with antibiotic drugs. His clinical symptoms improved. Concerning with brain abscess in this case, radiotherapy might break down of the blood-brain barrier and hematogenous bacterial brain abscess was formed by chance he suffered from sepsis before craniotomy. Carbon ion radiotherapy is promising treatment for nasal carcinomas, but radiation induced late complications should be cared.

Keywords

• Nasal carcinoma
• Adenoid cystic carcinoma
• Carbon ion radiotherapy
• Radiation necrosis
• Brain abscess