Radiation-Induced Vasculopathy-Juniper Publishers

Juniper Publishers-Journal of Anesthesia

Introduction

A 54 year-old man had several months of near-syncope and global weakness occurring typically with walking that worsened after starting antihypertensive medications including a diuretic. He had been treated for Hodgkin's lymphoma, presenting as a nasal mass as a young adult, with chemotherapy and external beam radiation. He had a normal head CT and felt somewhat better after receiving intravenous fluids but his symptoms returned on ambulation. MRI and MRA (Figure 1) of his head and neck showed occlusion of his left common carotid artery, highgrade stenosis (>75%) of his right internal carotid artery, and severe disease of both vertebral arteries; MRI showed numerous scattered punctate infarctions We started a Heparin infusion, held all antihypertensive medications allowing for permissive hypertension, and consulted Vascular Surgery for urgent right carotid endarterectomy. His recovery was complicated by postoperative infection but he had no further neurological symptoms at his three month follow-up visit.

Radiation-induced vasculopathy may take years to decades to become clinically symptomatic. Diuretics and vasodilators may worsen cerebral perfusion and exacerbate symptoms potentially leading to stroke [1-5].

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