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24-03-2013 | Neurology | Article

Headaches portend neurovascular events in pediatric brain tumor patients


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medwireNews: Severe recurrent headaches experienced by pediatric brain tumor survivors who received cranial radiation therapy (RT) is associated with a higher likelihood for a neurovascular event and thus signals neurovascular changes, shows a study.

The result shows that headaches can serve as a warning symptom of stroke and transient ischemic attack (TIA) that arise from radiation-induced vascular changes in the brain.

"[S]evere headaches in patients who received cranial RT should raise suspicion for impending brain ischemia," write Sarah Kranick (National Institutes of Health, Bethesda, Maryland) and colleagues in Neurology. "We, therefore, recommend that patients with severe recurrent headaches after cranial RT for brain tumors receive vigilant monitoring, and that consideration of prompt brain and neurovascular imaging be warranted."

Kranick and colleagues conducted a retrospective cohort study of 265 children with brain tumors (aged 0-21 years at diagnosis) who received cranial irradiation at a large tertiary care center. Treatment began between 1993 and 2002 with a median of 6 years of follow-up visits.

Headaches that were due to tumor progression, shunt malfunction or infection, or that appeared at the end of life were excluded from the study.

The analysis found that stroke or TIA occurred in seven (19%) of the 37 patients who had severe headaches, which was significantly more than the six (3%) of 228 patients who also experienced a neurovascular event but without any headache symptoms beforehand.

The association between severe headaches and subsequent arterial ischemic stroke or TIA remained significant after adjusting for age at diagnosis, inclusion of the circle of Willis in the radiation field, or chemotherapy treatment.

The authors were careful to note that because vascular imaging was not always obtainable, they could not conclusively demonstrate that patients with severe recurrent headache were more likely to have strokes or TIAs on the basis of vasculopathy.

"Further studies should address the role of large- and small-vessel vasculopathies in the pathogenesis of stroke and TIA after cranial RT, and how these changes clinically manifest," the research team suggests.

An accurate classification of the patients' headaches would also have been informative and can be useful in clinical practice, the authors suggest. "Separating brain tumor survivors into subgroups based on headache type may thus have predictive implications with regard to neurovascular events."

Future prospective studies need to evaluate the impact that antiplatelet therapy and migraine prevention might have on neurovascular events subsequent to cranial RT, they conclude.

By Peter Sergo, medwireNews Reporter

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