68 year old man with aphasia and facial droop

© 2014 American Academy of Neurology

Teaching NeuroImagesNeurology

Resident and Fellow Section

VIGNETTE

• A 68 year old man with a history of squamous cell carcinoma of the tongue treated with external beam radiation therapy in 2007, presented in 2013 with acute onset of expressive aphasia and right facial droop.

• MRI confirmed an infarct in the left frontal cortex. CTA revealed occlusion of the left internal carotid artery, new from 2007 imaging.

• Examination of the patient’s neck revealed radiodermatitis present only on the left.

Ehrlich, et al.© 2014 American Academy of Neurology

IMAGING

A B

C D

Ehrlich, et al.© 2014 American Academy of Neurology

Radiation-Associated Internal Carotid Artery Occlusion with Asymmetric Radiodermatitis

• Therapeutic neck irradiation has been associated with accelerated atheromatous changes, stenosis of the carotid arteries and increased risk of stroke.1, 2

• Asymmetric radiodermatitis may be a sign of underlying vasculopathy.

Ehrlich, et al.© 2014 American Academy of Neurology