House.

If radiation to the brain already sounds scary, this Italian and French multi-institutional compilation of some weird “radiation-related” neuro issues is flat out horrifying. It details 32 cases across 6 neuro-onc departments where new neuro symptoms presented at least 6 months (but as long as 43 years!) after brain radiation with no other discoverable etiology after in-depth medical and radiologic review. Most (n=26) were eventually grouped as “stroke-like” syndromes presenting with focal deficits, altered mental status, seizure or headache. Fortunately, most (n=22) saw a full recovery, many after high-dose steroids. This prompted a lit review producing 87 additional reported cases falling under this newly-opened umbrella of radiation-related stroke-like syndrome. TBL: What the literature currently describes as disparate, and exceedingly rare, late sequelae of brain radiation may in fact fall within a single, underappreciated entity of “stroke-like” syndromes deserving of unique treatment and prevention strategies. | Di Stefano, Eur J Neurol 2019