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Radiation-Induced Neuropsychiatric Manifestations in a Patient with Brain Metastasis: A Diagnostic and Therapeutic Challenges for Consultation-Liaison Psychiatrist
Identifier
029532
Type of Spiritual Experience
Background
A description of the experience
The Indian Journal of Palliative care
Radiation-Induced Neuropsychiatric Manifestations in a Patient with Brain Metastasis: A Diagnostic and Therapeutic Challenges for Consultation-Liaison Psychiatrist
Kumari Padma, Sagar Nanaware, [...], and Krishnaji Kulkarni
Abstract
The aim of this case report is to highlight diagnostic and therapeutic challenges for consultation-liaison psychiatrist in the case of radiation-induced neuropsychiatric syndrome. We report the case of a 61-year-old man presented with neurological and psychiatric manifestations following the radiation therapy for non-small cell lung carcinoma with brain metastasis. We have briefly reviewed and discussed the risk factors, clinical features, diagnostic, therapeutic, and preventive aspect of radiation-induced neuropsychiatric manifestations.
Keywords: Acute radiation syndrome, acute stroke, delirium, non-small cell lung carcinoma
INTRODUCTION
Lung cancer is the leading cause of cancer mortality worldwide, accounting about 16%–18% of total death from cancer.[1] Among those, approximately 7.4% of non-small cell lung cancer patients present with brain metastases (BM) and 25%–30% will develop BM during the course of the disease.[2,3]
The recently published Cochrane review reports that the palliative whole brain radiotherapy in the dose of 30 Gy over the period of 2 weeks achieves palliation in terms of symptom in almost 64%–85% patients with brain metastasis.[4,5] Although the cranial irradiation is relatively well-tolerated therapy, it can cause number of short- and long-term adverse effect such as acute toxicity, ischemic stroke, cerebral microbleed, delirium, and long-term cognitive deterioration.[6,7,8] Most of these manifestations are difficult to diagnose and treat due to nonspecific and overlapping symptoms.
The literature in terms of management of radiation-induced acute neuropsychiatric manifestations is limited. Through this case report, we present an interesting case of radiation-induced neurobehavioral syndrome in a patient with brain metastasis.