Objective:

To present a case of delayed radiation myelopathy (DRM) in a patient with multiple myeloma.

Background:

DRM is a rare complication of spinal irradiation which presents as progressive myelopathy months to years following radiation therapy.

Design/Methods:

58 year-old man with light chain multiple myeloma s/p auto-HSCT & palliative radiotherapy for a mild T6 compression fracture who presented with left leg weakness and urinary incontinence and neurological exam notable for weakness in the left leg, right-sided sensory level at T7 and hyperreflexia in the legs.  MRI of the spine showed marrow signal changes at T4-T8, a longitudinally extensive T4-T11 hyperintensity with cord enhancement at T7-T8.  Comprehensive work up included vitamin B12, vitamin E,MMA, HIV,RPR,HTLV 1/2,HbA1c,SPEP,ANA,SSA/SSB,copper,zinc,ACE,CRP, ESR and CSF analysis, all of which were unrevealing.  Given clinical history and radiographic findings as well as an unremarkable work up for other etiologies, patient was suspected to have delayed radiation myelopathy.  His clinical course was marked by mild radiographic improvement without accompanying clinical changes on dexamethasone which was discontinued due to lack of utility.  Patient ultimately progressed to paraplegia with associated worsening radiographic changes, was restarted on steroids and received a dose of Bevacizumab (VEGF inhibitor) with radiographic but lack of clinical improvement.  His course was further complicated by cerebellar ischemic strokes which were attributed to possible cardioembolic etiology. 

Results:

NA

Conclusions:

DRM occurs 6 months to years following radiation of the spinal cord. Risk factors are extent of irradiation, the dose per fraction and concurrent chemotherapy. In the absence of alternative etiology, delayed radiation myelopathy should be considered in patients presenting with spinal cord symptoms and relevant history and imaging.