Amyloid degeneration of the human brain following X-ray therapy.

Abstract

Case 1. History: C. R. (No. 10718), a white female, aged 42 years, entered the hospital in December, 1940, for the treatment of a basal cell carcinoma of the left temple. She was exposed to 6000 I' (as measured in air) in ten treatments within twelve days, with 600 r applied daily at 150 K.v. without filter (half value layer at 0.25 millimeters of copper). The size of the field was 57 x 41 millimeters. The treatment was concluded on January 15,1941; two months later the tumor had disappeared. Twenty-two months later, the tumor is said to have reoccurred in the same location; however, the nature of the lesion was not verified histologically, and it is not certain that it was carcinomatous. The left temporal area was subjected to a second series of X-ray treatments in another hospital, consisting of 3600 I' at 180 K.v. in twenty-four sessions of 150 I' per treatment. The exact size of the field and type of filter used were not reported. The second course of X-ray treatments was concluded on December 5, 1942. Following the second irradiation, the patient remained well for four years, and then, approximately seventy-one months after the first course of X-ray treatments, she became nervous, complained of general malaise, headaches; she experienced some speech difficulty and impaired vision. Examination: The skin of the left temple was atrophic, scaling, and red in color. There was no visible tumor in the skin. She manifested a mild expressive aphasia and showed bilateral papilledema with an elevation of four to five diopters on the right and of four diopters on the left. Pneumoventriculograms showed marked displacement to the right of the right lateral and third ventricles. Angiograms demonstrated displacement of the left anterior cerebral artery to the right across' the midline and downward. The artery was curved around a space-occupying lesion in the left posterior frontal area. An electroencephalogram indicated a space-occupying lesion, but not neoplastic in nature (Dr. B. K. Bagchi). Course: A left fronto-temporal osteoplastic craniotomy was performed on July 3, 1946 (Bassett). Skull and dura showed no significant changes. In the left superior and inferior frontal gyri, including the area of Broca, in the mid-portion of the left orbital gyri, and in the mid-portion of the superior temporal gyrus, the brain tissue was purplish-gray in color and well demarcated. The gross appearance of the lesion suggested a glioma. The affected tissue was removed with the exception of an area about 2 cm. square, which apparently ex-