Juvenile Stroke in a Patient with Severe Large Vessel Atherosclerosis of the Neck Decades after Radiotherapy for Nasopharyngeal Carcinoma: Are Iatrogenic Endocrinopathies Additional Risk Factors?

Introduction: Juvenile Nasopharyngeal carcinoma (NPC) is a rare head and neck cancer in Western Countries. Neck radiotherapy (RT) is a routine procedure for treating or preventing the nodal metastasis in NPC patients. Ionizing radiation from RT has been associated with enhanced atherosclerotic process of large vessel arteries of the neck and brain which results in higher incidence of cerebrovascular events. Clinical presentation: Herein we describe a 43-year-old man who presented with acute hemiparesis due to partial infarct in the anterior circulation of the brain due to severe steno-occlusive atherosclerosis of the neck arteries decades after RT for NPC. Additional risk factors were high levels of Low-Density Lipoprotein (LDL) and low Arterial Pressure (AP) possibly associated to post-RT secondary hypothyroidism and reduced corticotropin. Conclusion: Iatrogenic or acquired endocrinopathies may represent additional triggers of the atherogenic process and should be kept into account when dealing with rare forms of juvenile strokes in patients who had undergone to RT for either brain or neck cancers decades before.