Radiation-induced temporary alopecia after embolization of cerebral aneurysms
Nuria Marti, et al, Dermatology Online Journal 14 (7): 19
Abstract
A 29-year-old woman underwent 2 endovascular procedures for treatment of bilateral carotid-ophthalmic artery aneurysms. After each treatment, transient alopecia occurred over the occipital area and is presumed to be radiation induced.
Figure 1. Hair loss over her occipital area 2 months after initial embolization (A) and hair regrowth 1 year after the second embolization (B) Endovascular procedures have become widely used for the treatment of vascular lesions in the brain or spinal cord and their surrounding tissues. Radiation-induced adverse effects of endovascular procedures are seldom mentioned in the literature. Transient alopecia following a therapeutic embolization is a very rare complication [1, 2, 3, 4].
A 29-year-old woman was diagnosed with aneurysms of both carotid-opthalmic arteries. This patient had severe headache, but she was alert and oriented and without neurologic deficits. Her hair appeared normal.
The patient underwent two courses of embolization of the aneurysms with an interval of 3 months between courses. No neurologic deficits occurred after these procedures. However, hair loss over her occipital area was noted 2 weeks after the initial embolization. Physical examination revealed a 13 x 10 cm square patch of almost total hair loss on the occipital region.
The scalp was normal, exclamation-mark hairs were not visible; results of the pull test were normal. Her bilateral occipital and superficial temporal arteries had good pulses. A cutaneous biopsy was not performed because of the anticoagulant treatment of the patient. The hair regrew but 2 weeks after the second embolization, that was performed 3 months later, she again experienced the appearance of a similar patch of diffuse hair loss on the occipital scalp. The hair regrew 4 months after the occurrence of hair loss without treatment.
This patient underwent several angiographic examinations without side effects but alopecia appeared soon after the 2 courses of embolization. Hair loss due to arterial occlusion was considered unlikely. Radiation-induced hair loss was considered as the main cause for the hair loss in this patient. The estimated radiation exposure dose was more than 3 Gy.