Brain Neurorehabil.  2017 Mar;10(1):e1. 10.12786/bn.2017.10.e1.

Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

  • 1Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Rehabilitation Medicine, The Catholic University of Korea, Suwon St. Vincent Hospital, Suwon, Korea.
  • 3Department of Rehabilitation Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.


The brain necrosis induced by radiation therapy (RT) is an uncommon pathology of brain. A case of spontaneous hemorrhage at necrotic brain is also rare. A 52-year-old man who had nasopharyngeal carcinoma and had been treated with RT, presented with gait disturbance, dizziness, ataxia, dysarthria, and dysphagia. Magnetic resonance imaging (MRI) demonstrated progressed radiation necrosis of pons, and spontaneous hemorrhage at the site of necrosis. The hematoma was diminished by conservative treatment. However, the patient’s neurologic symptoms did not recover. Two years later, spontaneous bleeding recurred at necrotic brain. His neurologic symptoms worsened. One year later, his neurologic symptoms were more progressed. He showed severe dysphagia, profound weakness and respiratory failure. This case provides the description of relapsed spontaneous hemorrhage and medullary dysfunction caused by pontine necrosis and progressed post-radiation injury, complicated with hemorrhage, and urges caution in that the necrotic brain tissue may be vulnerable to bleeding.


Radiation Necrosis; Radiation Therapy; Pontine Hemorrhage
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