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An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy

We studied 114 primitive cerebral neoplasia, that were surgically treated, and underwent radiotherapy (RT), and compared their results to those obtained by 190 patients diagnosed with subcortical vascular dementia (sVAD). Patients with any form of primitive cerebral neoplasia underwent whole-brain r...

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Autores principales: Moretti, Rita, Caruso, Paola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555594/
https://www.ncbi.nlm.nih.gov/pubmed/32899565
http://dx.doi.org/10.3390/ijms21186506
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author Moretti, Rita
Caruso, Paola
author_facet Moretti, Rita
Caruso, Paola
author_sort Moretti, Rita
collection PubMed
description We studied 114 primitive cerebral neoplasia, that were surgically treated, and underwent radiotherapy (RT), and compared their results to those obtained by 190 patients diagnosed with subcortical vascular dementia (sVAD). Patients with any form of primitive cerebral neoplasia underwent whole-brain radiotherapy. All the tumor patients had regional field partial brain RT, which encompassed each tumor, with an average margin of 2.6 cm from the initial target tumor volume. We observed in our patients who have been exposed to a higher dose of RT (30–65 Gy) a cognitive and behavior decline similar to that observed in sVAD, with the frontal dysexecutive syndrome, apathy, and gait alterations, but with a more rapid onset and with an overwhelming effect. Multiple mechanisms are likely to be involved in radiation-induced cognitive impairment. The active site of RT brain damage is the white matter areas, particularly the internal capsule, basal ganglia, caudate, hippocampus, and subventricular zone. In all cases, radiation damage inside the brain mainly focuses on the cortical–subcortical frontal loops, which integrate and process the flow of information from the cortical areas, where executive functions are “elaborated” and prepared, towards the thalamus, subthalamus, and cerebellum, where they are continuously refined and executed. The active mechanisms that RT drives are similar to those observed in cerebral small vessel disease (SVD), leading to sVAD. The RT’s primary targets, outside the tumor mass, are the blood–brain barrier (BBB), the small vessels, and putative mechanisms that can be taken into account are oxidative stress and neuro-inflammation, strongly associated with the alteration of NMDA receptor subunit composition.
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spelling pubmed-75555942020-10-19 An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy Moretti, Rita Caruso, Paola Int J Mol Sci Review We studied 114 primitive cerebral neoplasia, that were surgically treated, and underwent radiotherapy (RT), and compared their results to those obtained by 190 patients diagnosed with subcortical vascular dementia (sVAD). Patients with any form of primitive cerebral neoplasia underwent whole-brain radiotherapy. All the tumor patients had regional field partial brain RT, which encompassed each tumor, with an average margin of 2.6 cm from the initial target tumor volume. We observed in our patients who have been exposed to a higher dose of RT (30–65 Gy) a cognitive and behavior decline similar to that observed in sVAD, with the frontal dysexecutive syndrome, apathy, and gait alterations, but with a more rapid onset and with an overwhelming effect. Multiple mechanisms are likely to be involved in radiation-induced cognitive impairment. The active site of RT brain damage is the white matter areas, particularly the internal capsule, basal ganglia, caudate, hippocampus, and subventricular zone. In all cases, radiation damage inside the brain mainly focuses on the cortical–subcortical frontal loops, which integrate and process the flow of information from the cortical areas, where executive functions are “elaborated” and prepared, towards the thalamus, subthalamus, and cerebellum, where they are continuously refined and executed. The active mechanisms that RT drives are similar to those observed in cerebral small vessel disease (SVD), leading to sVAD. The RT’s primary targets, outside the tumor mass, are the blood–brain barrier (BBB), the small vessels, and putative mechanisms that can be taken into account are oxidative stress and neuro-inflammation, strongly associated with the alteration of NMDA receptor subunit composition. MDPI 2020-09-05 /pmc/articles/PMC7555594/ /pubmed/32899565 http://dx.doi.org/10.3390/ijms21186506 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Moretti, Rita
Caruso, Paola
An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy
title An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy
title_full An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy
title_fullStr An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy
title_full_unstemmed An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy
title_short An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy
title_sort iatrogenic model of brain small-vessel disease: post-radiation encephalopathy
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555594/
https://www.ncbi.nlm.nih.gov/pubmed/32899565
http://dx.doi.org/10.3390/ijms21186506
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