A CASE OF JUVENILE STROKE CAUSEDBY ACTINIC CERVICAL ARTERIOPATHY

Introduction: Radiation Arteriopathy is a vascular disease characterized by progressive arterialstenosis that may occur after external radiotherapy (RT) directed to a specific body region affectedby malignant tumours. The arterial damage usually starts many years after the injury and thespecific pathogenesis is unknown, though atherosclerosis praecox, endothelial damage, adventitialfibrosis and vasa vasorum obliteration are likely involved mechanisms. In patients with previouslyirradiated neck or head cancers, supra aortic arteries can be affected in their segments exposed toradiations leading to a gradual lumen narrowing. This late complication leads to a progressivestenosis of extracranial cerebral arteries and consequently an increased risk of stroke. Case Report:A 29-years-old man was admitted to our Neurology ward due to a sudden onset of focal neurologicalimpairment. He was heavy smoker and drunk alcohol moderately, also he experienced similarsymptoms previously. MRI imaging showed a recent ischemic lesion in the middle cerebral arteryterritory and other previous ischemic events. A CT-angiography of the extracranial cerebral arteriesconfirmed a diffuse non focal narrowing of several cerebro-afferent vessels. More clinical andinstrumental investigations ruled out any involvement on different other vascular districts. A relevantinformation to establish the diagnosis was a history of nasopharyngeal carcinoma treated withRadiotherapy at age of 16 year-old, after other possible causes of juvenile stroke have beenexcluded. Conclusion: Patients who have been treated with Radiotherapy because of head or neckcancers represent a high risk population of developing a severe arteriopathy of the main extracranialarteries leading to recurrent stroke, even at a young age. Therefore, we propose a long-termfollow-up of this population and further studies in order to establish the best treatment.