Table 2.

Cerebrovascular Risk Factors, Screening Among Adult Brain Tumor Survivors

High-risk factors

RT to sellar/parasellar, prepontine cistern, posterior fossa

RT dose ≥ 50 Gy

Age > 55

Genetic risk factors (eg, neurofibromatosis type 1)

Concomitant chemotherapy (eg, cisplatin)

Extent of RT fields

Suggested screening recommendation

Small vessel

MRI brain (containing a minimum of T2, T2 Flair, T1 and DWI/ADC sequences)

High risk: consideration of screening of imaging at year 1, 3, and then 5-year intervals from the time of radiation.

Large vessel: intracranial (occlusive vasculopathy as well as aneurysm

High-resolution VWI-MRI head is preferred every 3–5 years based on imaging and clinical factors. If VWI-MRI is not available consider CTA head or MRA head

High risk: consideration of vessel imaging at 1, 3, and 5 years after RT and continue every 5 years if no vasculopathy is identified

Secondary vascular pathology (cavernomas, microhemorrhages)

Cavernomas and microhemorrhages: consideration of including T2* imaging (ex: GRE, SWI) at least every 5 years

Management

Vasculopathy

Referral to vascular neurology for consideration of antiplatelet agents and secondary stroke risk factor modification.

Moderate aerobic exercise 30 min 3–4 times a week