An Atypical Case: Bilateral Radiation Necrosis

Temporal lobe necrosis (TLN) is often seen in nasopharyngeal carcinoma secondary to less frequent other extracranial malignancies. Radiotherapy is one of the most frequently used methods in the treatment of nasopharyngeal carcinoma. This method can have many side effects. One of the side effects associated with high-dose radiotherapy is cerebral necrosis. Cerebral radiation is the sum of the dose of radiotherapy given as the most important risk factor for necrosis. It is often seen within the first 5 years after the completion of treatment. At present, the development of temporal lobe necrosis, radiotherapy planning, and current techniques are less common than their predecessors. The combination of radiotherapy and chemotherapy treatment also increases the risk of cerebral necrosis. TLN symptoms are a highly variable spectrum. For this reason, the lesion can mimic many diseases. Differential diagnosis of TLN includes intracranial nasopharyngeal carcinoma (NPC). Expansion, second primer intracranial neoplasm, brain metastasis, meningeal spread and brain abscess. On the way to diagnosis, imaging methods can help, but no method is specific. However, magnetic resonance (MR) imaging features commonly seen in radiation necrosis are a soap-bubble-like core and a Swedish cheese-like appearance. In the MR spectroscopy; there is no increase in the colonic peak in the lesion, in the MR perfusion; perfusion increase in perilesional edema and the lack of diffusion restriction is a finding that supports the diagnosis of radiation necrosis. Imaging features can be diagnosed by evaluating with history and clinical findings. Accurate diagnosis and early detection is very important, as it will avoid unnecessary interventions. We will talk about the diagnosis of nasopharynx carcinoma and bilateral temporal lobe necrosis secondary to radiation at different times in a patient who has completed radiotherapy treatment.