Guidelines for Complications of Cancer Treatment Vol VIII Part B

Differential Diagnosis: This sign is nonspecific, and othercauses should be considered in patients 8 , includingchemotherapy (cisplatin or docetaxel), spinal tumor, vitaminB12 deficiency, herpes zoster, or even radiation inducedworsening of preexisting multiple sclerosis . 9Pathologic Diagnosis: Pathological diagnosis is not required.Its need may arise only to rule out other causes like tumorprogression.Management: There is no known specific treatment for thiscondition, and none is required, as recovery occurs in mostcases. Corticosteroids like dexamethasone have been provenbeneficial in animal models. 10Follow up: Early-delayed spinal cord disorder is not predictiveof a possible evolution to the much more serious progressivemyelopathy. Patients may be convinced about thetemporariness of the symptoms and subjected to routine followup. 11Delayed Radiation MyelopathyClinical detection: Delayed radiation myelopathy may beginabruptly or more often in a progressive way; the patientscomplain of sensory and/or motor deficits leading to para- orquadriparesis. A typical initial clinical presentation is a Brown-Sequard’s syndrome, consisting of a motor deficit associatedwith ipsilateral sensory loss affecting tactile, vibration, andproprioception on one side, and contralateral sensory lossaffecting mainly temperature and pain sensory modalities. Insome patients, a transverse myelopathy develops with bilateralleg weakness and sensory loss up to the irradiated region. Somepatients also experience pain. Bladder and bowel sphincter aswell as diaphragmatic dysfunction (in upper cervical spinalcord lesions) are possible. The evolution of delayed radiationmyelopathy varies; in some patients the symptoms stabilize,while in others they progress to a complete deficit.331