CASE 17897 Published on 14.10.2022

Mineralizing microangiopathy as a long term complication of radiotherapy



Case Type

Clinical Cases


Natanael Vázquez, Ricardo Triana

Silao General Hospital, Radiology Department, Silao, Guanajuato, Mexico


14 years, male

Area of Interest Neuroradiology brain ; Imaging Technique CT
Clinical History

A 14-year-old male patient with history of supratentorial ependymoma that was excised and received chemotherapy and radiotherapy 4 years prior was brought for evaluation due to persistent headache.

Imaging Findings

A contrast enhanced CT scan was obtained showing surgical changes associated with tumoral excision, bilateral subdural hygroma, a left ventricular shunt, and multiple calcified gyriform subcortical areas in both frontal and temporal lobes; there were also calcifications located at the basal ganglia bilaterally.


Chemotherapy and radiotherapy for the management of CNS neoplasms have a toxic effect on brain tissue, being brain tissue volume loss the most common long-term complication [1]

Mineralizing microangiopathy is an rare long-term complication of these therapies in children, being present in 28% of survivors, and it´s more frequent when the therapies are combined [2]. It represents the deposition of calcium in small vessels secondary to fibrinoid necrosis [3]. Therapy for meduloblastoma is recognized as the main cause in some series, while treatment for leukaemia and craneopharyngiomas represent a common cause as well. The most prevalent symptoms are headache, convulsions and slurred speech, although some patients are asymptomatic [4]

On imaging, it presents a dystrophic calcification located at the basal ganglia, cortico-subcortical junction and cerebellum [5]. When located at the basal ganglia, it may increase the risk of stroke after minor trauma due to affection of lenticulostriate arteries [6].

No firm recommendations are available at the moment regarding the management of these patients [7]; however, preventive care is recommended to minimize reversible stroke risk factors [8].


Mineralizing microangiopathy is an uncommon complication of CNS neoplasms management. As survival rates increase among these patients, it will become more prevalent in the future. Since it increases the risk of basal ganglia stroke, it is very important for radiologists to learn to recognize it so that it’s not mistaken for other entities, and preventive management can be started early.

‘Written informed consent for publication from the patient’s mother has been obtained.’

Differential Diagnosis List
Mineralizing microangiopathy
Leptomeningeal carcinomatosis
Cortical laminar necrosis
Subarachnoid haemorrhage
Fahr's disease
Final Diagnosis
Mineralizing microangiopathy
Case information
DOI: 10.35100/eurorad/case.17897
ISSN: 1563-4086