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Neuro-Oncology 2003 5(2):121-127; doi:10.1093/neuonc/5.2.121
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© 2003 by the Society forNeuro-Oncology

Reversible, strokelike migraine attacks in patients with previousradiation therapy

J. D. Bartleson1, Karl N. Krecke, Brian P. O'Neill and Paul D. Brown

Departments of Neurology (J.D.B., B.P.O.) and Radiology (K.N.K) and Division ofRadiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN 55905, USA

1 Address correspondence and reprint requests to J. D. Bartleson, Mayo ClinicDepartment of Neurology, 200 First Street Southwest, Rochester, MN 55905(bartleson.john{at}mayo.edu)


  Abstract

We report 2 adults with a past history of radiation therapy to the head formalignancy (one with primary B-cell lymphoma confined to the skull and theother with multiple hemangioendotheliomas) who developed episodes consistentwith migraine with and without aura. In addition to more typical migraineattacks and beginning many years after their radiation therapy, both patientshave experienced infrequent, stereotyped, prolonged, reversible neurologicdeficits associated with headache, occasional seizures, and striking,transient, cortical gadolinium enhancement of the posterior cerebral gyri onMRI. Interictal MRI brain scans show stable abnormalities consistent with thepatients' previous radiation therapy. The neurologic deficits often progressedover a few days, sometimes lasted weeks, and completely resolved.Electroencephalograms did not show epileptiform activity. Thoroughinvestigation showed no residual or recurrent tumor and no recognized causefor the patients' attacks.

We postulate a causal relationship between the patients' remote radiationtherapy and their prolonged, strokelike migraine attacks. Radiation-inducedvascular changes could provoke the episodes, with or without an underlyingmigraine diathesis. Recognition of this syndrome can help avoid invasivetesting.

Received October 17, 2002; Accepted December 31, 2002


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