'Complicated migraine-like episodes' in children following cranial irradiation and chemotherapy

A. Shuper, R. J. Packer, L. G. Vezina, H. S. Nicholson, D. Lafond

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Neurologic sequelae may occur months to years after cranial irradiation. The site of primary damage is probably the vascular endothelium. Over a 2.8- year period, four children with brain tumors, a mean of 11 years of age at diagnosis (range, 6.5 to 15.5 years), had new onset of severe intermittent unilateral headaches associated with nausea, episodic visual loss, hemiparesis, aphasia, or hemisensory loss. The headaches lasted 2 to 24 hours. All patients had previously received whole-brain (2,400 to 3,600 cGy) and additional local boost (1,800 to 3,100 cGy) cranial irradiation, as well as cisplatin-, lomustine-, and vincristine-containing chemotherapy regimens. Symptoms began 1.2 to 2.8 years after the diagnosis, when all had stable disease and were off treatment. MRI studies were unchanged, and CSF cytology, EEGs, echocardiograms, and magnetic resonance angiograms were normal in all. Cerebral angiograms, performed in three children, were normal but led to severe headaches and neurologic deficits (hemiparesis in one and visual loss in two) that resolved after 24 to 48 hours. Response to antimigraine and antiplatelet medications was variable. We conclude that (1) 'complicated migraine-like episodes' may occur in children after cranial irradiation and chemotherapy as a sequela of therapy; (2) these headaches may not be the harbinger of impending strokes, severe intracranial vasculitis, or tumor recurrence; and (3) while cerebral angiography may be useful in differential diagnosis, it may cause transient worsening of symptoms.

Original languageEnglish (US)
Pages (from-to)1837-1840
Number of pages4
JournalNeurology
Volume45
Issue number10
StatePublished - 1995
Externally publishedYes

Fingerprint

Cranial Irradiation
Migraine with Aura
Headache
Drug Therapy
Paresis
Angiography
Lomustine
Cerebral Angiography
Aphasia
Vascular Endothelium
Vincristine
Vasculitis
Neurologic Manifestations
Brain Neoplasms
Nausea
Nervous System
Cisplatin
Cell Biology
Electroencephalography
Differential Diagnosis

ASJC Scopus subject areas

  • Neuroscience(all)
  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Shuper, A., Packer, R. J., Vezina, L. G., Nicholson, H. S., & Lafond, D. (1995). 'Complicated migraine-like episodes' in children following cranial irradiation and chemotherapy. Neurology, 45(10), 1837-1840.

'Complicated migraine-like episodes' in children following cranial irradiation and chemotherapy. / Shuper, A.; Packer, R. J.; Vezina, L. G.; Nicholson, H. S.; Lafond, D.

In: Neurology, Vol. 45, No. 10, 1995, p. 1837-1840.

Research output: Contribution to journalArticle

Shuper, A, Packer, RJ, Vezina, LG, Nicholson, HS & Lafond, D 1995, ''Complicated migraine-like episodes' in children following cranial irradiation and chemotherapy', Neurology, vol. 45, no. 10, pp. 1837-1840.
Shuper A, Packer RJ, Vezina LG, Nicholson HS, Lafond D. 'Complicated migraine-like episodes' in children following cranial irradiation and chemotherapy. Neurology. 1995;45(10):1837-1840.
Shuper, A. ; Packer, R. J. ; Vezina, L. G. ; Nicholson, H. S. ; Lafond, D. / 'Complicated migraine-like episodes' in children following cranial irradiation and chemotherapy. In: Neurology. 1995 ; Vol. 45, No. 10. pp. 1837-1840.
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