Post-radiation optic neuropathy

IF 2.4 Q2 CLINICAL NEUROLOGY

PRACTICAL NEUROLOGY Pub Date : 2024-09-10 DOI:10.1136/pn-2024-004255

Edward Margolin, Armin Handzic

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Abstract

A middle-aged man developed subacute painless visual loss in the left eye leading to no light perception, and 2 weeks later developed subacute visual loss in the right eye to no light perception. He had a history of resected pituitary macroadenoma. MR scan of brain and orbits with contrast showed short prechiasmatic segments of enhancement in each optic nerve. Cerebrospinal fluid analysis was normal. Extensive diagnostic work-up was unrevealing but review of medical records identified a history of prophylactic radiotherapy to the pituitary gland following pituitary macroadenoma resection 1.5 years before. We diagnosed post-radiation optic neuropathy. This condition typically occurs 1–1.5 years after the radiotherapy given near the visual pathway. Its pathophysiology presumably relates to an endotheliopathy of the vasa nervosum supplying the optic nerve due to free radical accumulation following radiotherapy. It manifests with unilateral or bilateral sequential severe visual loss with imaging showing characteristic enhancement of the short segment of the affected intracranial optic nerve. There is no available definitive treatment, but hyperbaric oxygen therapy, given shortly after onset of visual loss, is a promising treatment. Data are available upon reasonable request.

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放疗后视神经病变

一名中年男子左眼出现亚急性无痛性视力下降，没有光感，2周后右眼出现亚急性视力下降，没有光感。他有切除垂体大腺瘤的病史。用造影剂对大脑和眼眶进行核磁共振扫描显示，每条视神经都有短的桥粒前段强化。脑脊液分析正常。广泛的诊断检查没有发现异常，但查看病历后发现，患者在1年半前接受垂体大腺瘤切除术后，曾对垂体进行过预防性放疗。我们诊断为放疗后视神经病变。这种情况通常发生在对视觉通路附近进行放疗后的 1-1.5 年。其病理生理学可能与放疗后自由基蓄积导致的视神经血管内皮病变有关。它表现为单侧或双侧连续性严重视力丧失，影像学显示受影响的颅内视神经短节有特征性增强。目前尚无确切的治疗方法，但在视力丧失发生后不久进行高压氧治疗是一种很有前景的治疗方法。如有合理要求，可提供相关数据。

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来源期刊

PRACTICAL NEUROLOGY Medicine-Neurology (clinical)

CiteScore

3.70

自引率

3.60%

发文量

113

期刊介绍： The essential point of Practical Neurology is that it is practical in the sense of being useful for everyone who sees neurological patients and who wants to keep up to date, and safe, in managing them. In other words this is a journal for jobbing neurologists - which most of us are for at least part of our time - who plough through the tension headaches and funny turns week in and week out. Primary research literature potentially relevant to routine clinical practice is far too much for any neurologist to read, let alone understand, critically appraise and assimilate. Therefore, if research is to influence clinical practice appropriately and quickly it has to be digested and provided to neurologists in an informative and convenient way.