Radiation myelopathy (RM) is a relatively rare disorder characterized by white matter lesions of the spinal cord resulting from irradiation. It is divided into two forms by the latent periods: transient RM and delayed RM. The delayed RM develops usually non-transverse myelopathy symptoms such as dissociated sensory disturbance, unilateral leg weakness, and gait disturbance with asymmetric steps. Spinal MRI shows initially cord swelling and long T1/T2 intramedullary lesion with enhancement, then exhibits cord atrophy. Histopathological findings of delayed RM are white matter necrosis, demyelination, venous wall thickening and hyalinization. Glial theory and vascular hypothesis have been proposed to explain its pathophysiology. Several therapies such as adrenocorticosteroid, anticoagulation and hyperbaric oxygen have been tried to this disease with variable benefits. Radiation plexopathy is classified into two major types by the location:
- radiation-induced brachial plexopathy (BP) and
- radiation-induced lumbosacral plexopathy (LSP).
The BP initially emerges as arm and shoulder pain, whereas LSP as leg weakness. Myokymia and fasciculations are observed in both types. Electrophysiological study reveals findings of peripheral neuropathy. It is often difficult to distinguish the radiation plexopathy from cancer invasion to the plexus, but MRI is useful to differentiate between these diseases. Pathological findings are
- small vessel obstruction,
- thick fibrosis,
- axonal degeneration and demyelination.
Its pathomechanism is presumed that radiation-induced fibrous tissue compresses the nerve root as well as microvascular obstruction of the nerve. Adrenocorticosteroid and anticoagulation are considered as the strategy for symptomatic relief.”
“Plexopathy is a disorder affecting a network of nerves, blood vessels, or lymph vessels.[1] The region of nerves it affects are at the brachial or lumbosacral plexus. Symptoms include pain, loss of motor control, and sensory deficits…Both plexopathies can also occur as a consequence of radiation therapy,[3] sometimes after 30 or more years have passed, in conditions known as Radiation-induced Brachial Plexopathy (RIBP)[4] and Radiation-induced Lumbosacral Plexopathy (RILP).[5]…”
“Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.[1]
In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar–sacral spine can be manifested with symptoms in the foot…”
“Myelopathy describes any neurologic deficit related to the spinal cord.[1] When due to trauma, it is known as (acute) spinal cord injury…
Clinical signs and symptoms depend on which spinal cord level (cervical,[5] thoracic, or lumbar) is affected and the extent (anterior, posterior, or lateral) of the pathology, and may include:
- upper motor neuron signs—weakness, spasticity, clumsiness, altered tonus, hyperreflexia and pathological reflexes, including Hoffmann’s sign and inverted Plantar reflex(positive Babinski sign);
- lower motor neuron signs—weakness, clumsiness in the muscle group innervated at the level of spinal cord compromise, muscle atrophy, hyporeflexia, muscle hypotonicity or flaccidity, fasciculations;
- sensory deficits;
- bowel/bladder symptoms and sexual dysfunction…”
“There will be 1.2 million cases of invasive cancer diagnosed in the United States this year. Half of those patients will receive radiation therapy as part of their treatment program. Serious radiation complications will occur in 5% of patients receiving radiation therapy. This represents about 30,000 cases per year.Often, delayed effects of radiation are diagnosed when an additional insult to the tissue such as surgery or trauma occurs. This activity explains how to properly evaluate radiation induced injury and highlights the role of the interprofessional team in caring for patients with this condition.
Objectives:
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Describe the pathophysiology of radiation induced tissue injury.
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Review the presentation of patients with radiation induced tissue injury.
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Summarize the treatment options for radiation induced tissue injury.
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Outline the importance of enhancing care coordination among the interprofessional team to ensure proper evaluation and management of radiation induced tissue injury.
