Cognitive decline and swiss cheese aspect revealing temporal radionecrosis after nasopharyngeal carcinoma radiation therapy: case report and literature review

Background The radiation therapy effectiveness is certain in naso pharyngeal carcinoma NPC and other head and neck malignancies In this context cerebral radionecrosis CRN is a late radiotherapy related side effect Its incidence is above when the total dose is less than grays and the fraction size less than grays We report a rare case of late cerebral radio necrosis its clinical manifestation MRI specific aspect compared to its main differential diagnosis brain metastatic tumor and the evolution under specific treatment with a review of reported cases over the literature Case report years old man diagnosed for having nasopharyngeal carcinoma and was treated by chemotherapy and external radiotherapy years after later he presented progressive cognitive decline with phasic and mnesic complaints associated to balance disorder Clinical examination objectified dementia detected by Montreal Cognitive Assessment MoCA score with normal Mini Mental State MMS associated to pyramidal and vestibular syndrome Cerebral MRI showed swiss cheese and soap bubble aspect in left temporal lobe and spectroscopy showed decreased creatinine and N acetyl aspartate peak He was treated as having temporal radio necrosis by hyperbaric oxygen corticotherapy and anti platelets His clinical and radiological condition improved Conclusion We learn that cognitive decline may be the revealing symptom of cerebral radio necrosis In this case MoCA test showed more sensitivity Thus clinician must bear in mind the risk of cerebral radio necrosis CRN as much as metastatic or recurrent brain tumor in such situation The MRI with specific pattern could help in distinguish these entities Corticosteroid associated to hyperbaric oxygen and anti platelets improve the course of CRN The use of promoting agent anti VEGF Bevacizumab should be clarified by more prospective studies