Management and Long-Term Outcomes of Patients With Recurrent Stroke-Like Episodes After Cranial Radiotherapy

Background: Recurrent Stroke-Like Episodes of transient negative neurologic symptoms are a long-term consequence of cranial radiation therapy (RT) that may lead to significant functional impairment and worsen quality of life. We assessed management patterns and clinical course at our institution to assess optimal management strategy and understand long-term outcomes. Methods: We conducted a retrospective review of all patients with recurrent negative neurologic symptoms after cranial RT who were treated at Mayo Clinic (Rochester), with follow-up extending through October 2021 with a goal of assessing for clinical change in the setting of medical management. Descriptive statistics and Fisher exact tests were performed for group comparisons. Results: Twenty-five patients were included. Median age at diagnosis was 28.7 years (range: 3.0 to 65.8). Median time from RT to symptom onset was 14.6 years (range: 3.3 to 30.5). The most common presentations included hemiparesis (56%), visual field (33%) and hemisensory (22%) loss, and aphasia (22%). Therapeutics used specifically for management of recurrent episodes included antiseizure medications (92%), antiplatelets (68%), verapamil (52%), statins (48%), glucocorticoids (24%), antivirals (20%), and angiotensin converting enzyme inhibitor/ Angiotensin receptor blockers (16%). Antivirals were less commonly used in patients with cessation (Fisher exact, P =0.0235). Progressive encephalopathy was more commonly seen in those without cessation (Fisher exact, P =0.0072), and in all patients who died at last follow-up. Conclusions: Although retrospective experience from a single institution, our cohort represents one of the largest with management data reported for this complex clinical scenario. We hope that our findings may be used as a reference for clinicians in the management of this challenging clinical scenario.