A case of brain radionecrosis
This clinical report, published in the Journal of Neurology Research is aimed to describe a case of cerebral radionecrosis after a radiation therapy for skin cancer, with a literature revision for discussing the differential diagnosis with primary or secondary brain cancers.

A 69-year-old man looked for medical attention for an erythematous and irregular macula on a left pre-auricular region on September 2012. He was submitted to a surgical resection on February 2013, with compromised deep margin, with the pathology being epidermoid carcinoma. Patient received complimentary treatment with radiation therapy in between April and June 2013 with 66 Gy (33 sessions of 2 Gy). In mid 2014, he started with a confusional state and motor aphasia.

The enhanced MRI showed an irregular area of hypersignal with hypointense content on T1WI on insular lobe. He was submitted to a stereotactic biopsy in December 2014, which showed necrosis of cerebral tissue. He received corticotherapy and improved, but had another sudden worsening of same symptoms in July 2015. Emergency head CT showed worsening of cerebral edema in left temporal fossa with sings of intracranial hypertension.

The worsening of symptoms were deviation of midline and an organized lesion that was approached for resection. After 2 days, he was in a coma, with anisocoria and worsening of hypodensity on head CT. A decompressive craniectomy was performed and the pathology showed again just cerebral necrosis.

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