Delayed radiation myelopathy (DRM) is a rare complication of radiotherapy, especially when the total dose delivered to the spinal cord is less than 50 Gy.1 From the limited data reported on the radiological features of DRM, typical MRI changes of cord swelling and gadolinium enhancement on T1 weighted images and increased intramedullary signal on T2 weighted images often correlate well with progression of neurological symptoms. We report a case of DRM in which the clinical features remained static at a level corresponding only to the lower end of the abnormal intramedullary lesion seen on MRI, without radiological evidence of blood-brain barrier breakdown, suggesting that pathological changes to the spinal cord after radiation are not always displayed as visible changes on MRI.

A previously well 71 year old woman presented in December 1997 to the ear, nose and throat department with hoarseness and difficulty swallowing, having discovered a lump in the right side of her neck. Laryngoscopy showed a right pyriform fossa tumour, histologically confirmed as a lymphoepithelioma after biopsy. Staging neck CT showed extensive tumour in the right pyriform sinus and lateral pharyngeal wall with associated lymphadenopathy extending to the thoracic inlet.

Between April and May 1998, she received chemotherapy comprising 5-fluorouracil and cis-platinum. Radiotherapy was started in June 1998 with fields covering the pyriform sinus and neck, anterior supraclavicular fossa, and posterior neck. The calculated dose …