Chronic Progressive Radiation Myelopathy

Abstract

Ten patients with chronic progressive radiation myelopathy were studied at the Mayo Clinic. Most of them had primary carcinomas of head or neck and all had received radiation therapy. The interval between termination of radiation and onset of neurologic symptoms varied from 5 1/2 to 30 months. The lower extremities were usually affected first. Sensory symptoms predominated. The spinal cord disease was cervical in eight and dorsal in two, corresponding to the segment of the cord irradiated. In four patients, the striking neurologic finding was a Brown-Séquard syndrome, whereas in six the picture was that of an incomplete transverse myelopathy. Myelograms were normal in all but one patient. Seven patients had died; average survival time was ten months. The differential diagnosis mainly concerned intramedullary tumor metastasis and "remote" carcinomatous myelopathy.