Case reportTemporary alopecia after subarachnoid haemorrhage
Introduction
Therapeutic endovascular interventional procedures for complex vascular anomalies are often associated with the prolonged and recurrent use of fluoroscopic imaging. This may inadvertently cause patients to be exposed to substantial amounts of radiation.[1], [2], [3], [4], [5], [6] In previously reported cases, alopecia has occurred in procedures involving therapeutic embolization of arteriovenous malformations[2], [5], [7], [8], [9], [10], [11] or tumours12 where prolonged and recurrent sittings are often required. In the present study, two patients developed temporary alopecia after a single procedure for the direct endovascular coiling of posterior circulation aneurysms. The pertinent medical literature is reviewed, with a discussion of the condition’s aetio-pathogenesis and the measures that can be undertaken to minimize this complication.
Section snippets
Case 1
A 31-year-old male patient experienced sudden onset of severe headache, neck stiffness, photophobia, and vomiting, one day prior to admission. He was non-hypertensive and non-diabetic and had no previous history of cerebrovascular accident. There were no deficits apparent on neurological examination (World Federation of Neurosurgical Societies Classification [WFNS] grade I). A computed tomography (CT) scan revealed a subarachnoid haemorrhage with evidence of blood mainly in the interpeduncular,
Etiopathogenesis
Temporary alopecia and other skin changes following therapeutic embolization of arteriovenous malformations[2], [5], [7], [8], [9], [10], [11] and tumours12 have been previously documented in the literature. They are often related to the multiple fluoroscopic exposures and staged sessions required for these lesions. The changes may also be secondary to compromise of the external carotid blood supply of the scalp,11 either due to therapeutic embolization of the vessel or to radiation-induced
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Cited by (19)
The Patient Size Setting: A Novel Dose Reduction Strategy in Cerebral Endovascular Neurosurgery Using Biplane Fluoroscopy
2018, World NeurosurgeryCitation Excerpt :Occurrence of a fluoroscopy sentinel event triggers a mandatory root cause analysis, and patients must be notified of their high radiation exposure. These interventions are required because of the myriad reports of skin reactions,10,16,17 alopecia,18-22 cataract formation, and delayed neoplasia.7,10,23 To combat this phenomenon, dose reduction protocols have been developed.
Geometric alopecia after embolization of a ruptured aneurysm
2015, Actas Dermo-SifiliograficasEntrance surface dose in cerebral interventional radiology procedures
2014, Radiation MeasurementsCitation Excerpt :In particular, in therapeutic interventional procedures performed for vascular anomalies such as aneurisms, arteriovenous malformations and arteriovenus fistulas, patients are often exposed to substantial amounts of radiation associated with the use of fluoroscopic imaging (Huda and Peters, 1994; Mooeney et al., 2000). It has been reported that in procedures involving therapeutic embolization of arteriovenous malformations patients have developed alopecia (Huda and Peters, 1994; Mooeney et al., 2000; Nannapaneni et al., 2007; Tosti et al., 1999; Wen et al., 2003). The dosimetric quantity used in interventional radiology for dose measurements on patients is the entrance surface dose (Zoetelief et al., 2000).
Temporary localized alopecia following neuroradiological procedures: 18 cases
2014, Annales de Dermatologie et de VenereologieDirect measurement of patient's entrance skin dose during neurointerventional procedure to avoid further radiation-induced skin injuries
2010, Clinical Neurology and NeurosurgeryCitation Excerpt :Radiation-induced skin injuries (RSIs) such as epilation or ulceration have been reported more frequently in recent years because of the increasing number of interventional radiological procedures, which are less invasive than open surgery [1]. Although several cases of temporary epilation were reported as RSI following neurointerventional procedures [2–11], an ideal dosimetry technique for calculating the patient's entrance skin dose (ESD) has yet to be established, meaning that the ESD at the region of RSI cannot be determined correctly. Clinicians have paid little attention to RSIs or to establishing a method for avoiding RSIs.
Transient rectangular alopecia after aneurysm embolization: A case report
2009, Actas Dermo-Sifiliograficas