INTRACRANIAL LARGE VESSEL VASCULOPATHY AND ANAPLASTIC MENINGIOMA 19 YEARS AFTER CRANIAL IRRADIATION FOR ACUTE LYMPHOBLASTIC-LEUKEMIA

A child was diagnosed in 1969 as having acute lymphoblastic leukaemia (ALL) and received chemotherapy. On bone marrow relapse in 1973, he wa s treated with cranial irradiation (20 Gy) in addition to chemotherapy . He continues in complete remission 19 years after his relapse. At ag e 25 years,he presented with headaches and left hemiparesis. Computeri sed tomograph demonstrated a large, enhancing right-sided intracranial tumour. Angiography was performed and showed the right internal carot id artery was occluded. Most of the right hemisphere was supplied from the external carotid via the middle meningeal artery. The left poster ior cerebral artery and the left anterior cerebral artery were absent presumably as a result of radiation-induced arteritis. A resection of an anaplastic meningioma arising from the right sphenoidal ridge was a chieved. There was a rapid improvement in function and he returned to work. Vasculopathy of the large intracranial arteries has been describ ed after high dose radiation. It may occur as in this case after moder ate dose radiation. There is a correlation with meningioma. There is a possibility that large artery vasculopathy will be present in a propo rtion of patients irradiated for ALL. The long lag time between irradi ation and the development of meningioma may mean that, as survivors of childhood ALL enter their third decade since cure, this tumour may be seen increasingly. (C) 1995 Wiley-Liss, Inc.