1036. CASE REPORT: INTRACEREBRAL HEMORRHAGE CAUSED BY RADIATION-INDUCED CAVERNOUS ANGIOMA

Authors: Bruno Henrique Dallo Gallo; Bruno Gallo; Carlos Mattozo; Luana Rocha; Eder Alves; Heraldo Neto; Larissa Silva; Adriano Maeda; Alexandre Francisco (Curitiba, Brazil)

Introduction:

Case report of a female patient, 33 years old, who was operated for an astrocytoma recurrence and submitted to radiotherapy with IMRT technique with a dose of 54Gy. Five years later, there was the appearance of a cavernous angioma in the left insular region, evolving with intracerebral hemorrhage seven months later.

Methods:

The information contained in this study was obtained by reviewing the medical record, interviewing the patient, photographic record of the diagnostic methods to which the patient was submitted and reviewing the literature.

Results:

A 33-year-old female patient. Operated by low grade astrocytoma in the right temporal region 10 years ago. During image follow-up, 4 years later, he developed convulsive seizures. Imaging tests showed local recurrence. It was then submitted to a new surgical approach with tumor removal and temporal lobectomy. The report was compatible with diffuse Grade II Astrocytoma. After that, she underwent radiotherapy with IMRT technique with a dose of 54Gy. Five years after the last surgery, Magnetic Resonance Imaging (MRI) showed tumor stability. However, there was a cavernous angioma in the left insular region. Due to location, we opted for image tracking. Seven months later, there was a sudden onset of dysphasia and mental confusion, and MRI of the skull showed intracerebral hemorrhage of the left temporo-insular region compatible with cavernous angioma bleeding. There was associated midline deviation. The patient was submitted to neuronavigation guided microsurgical resection of cavernous angioma.

Conclusion:

This case report illustrates cavernous angioma as an expected complication of radiotherapy in a female adult. The relatively rapid evolution to a cerebral hemorrhage calls attention to better criteria in the decision on image follow-up versus surgical approach of these lesions.