68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching...
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Transcript of 68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching...
68 year old man with aphasia and facial droop
© 2014 American Academy of Neurology
Teaching NeuroImagesNeurology
Resident and Fellow Section
VIGNETTE
• A 68 year old man with a history of squamous cell carcinoma of the tongue treated with external beam radiation therapy in 2007, presented in 2013 with acute onset of expressive aphasia and right facial droop.
• MRI confirmed an infarct in the left frontal cortex. CTA revealed occlusion of the left internal carotid artery, new from 2007 imaging.
• Examination of the patient’s neck revealed radiodermatitis present only on the left.
Ehrlich, et al.© 2014 American Academy of Neurology
IMAGING
A B
C D
Ehrlich, et al.© 2014 American Academy of Neurology
Radiation-Associated Internal Carotid Artery Occlusion with Asymmetric Radiodermatitis
• Therapeutic neck irradiation has been associated with accelerated atheromatous changes, stenosis of the carotid arteries and increased risk of stroke.1, 2
• Asymmetric radiodermatitis may be a sign of underlying vasculopathy.
Ehrlich, et al.© 2014 American Academy of Neurology