Online citations, reference lists, and bibliographies.
Please confirm you are human
(Sign Up for free to never see this)
← Back to Search

SMART (Stroke-Like Migraine Attacks After Radiation Therapy) Syndrome: A Case Study With Imaging Supporting The Theory Of Vascular Dysfunction

R. Biju, Ashraf Dower, Benjamin G. Moon, P. Gan
Published 2020 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
Patient: Male, 28-year-old Final Diagnosis: SMART syndrome Symptoms: Seizure Medication: — Clinical Procedure: — Specialty: Neurosurgery Objective: Rare disease Background: SMART (Stroke-like Migraine Attacks after Radiation Therapy) syndrome is an uncommon delayed complication of cerebral radiotherapy. Less than 50 cases have been reported in the literature since it was first described in 1995. On average, presentation is about 20 years after radiotherapy, and patients commonly present with headaches, complex seizures, and stroke-like symptoms. The exact pathophysiology of the disease remains poorly understood, but one theory suggests radiation-induced vascular dysfunction. Case Report: We present one such case of a 28-year-old man who presented to our Emergency Department with a gradually progressive severe headache and right-sided weakness developing over a few hours. MRI played a central role in the diagnosis of SMART syndrome, with serial studies demonstrating and supporting the theory of vascular dysfunction. The condition is usually self-limiting, and most patients achieve complete recovery of symptoms, as did ours. Its optimal management remains unclear. Conclusions: Better understanding of the imaging findings in SMART syndrome may help differentiate it from tumor recurrence, cerebral infections, or vasculitis. Because the diagnosis of this condition portends a significantly better prognosis and substantially alters patient expectation and management, it is important that clinicians are aware of the usual delayed presentation, symptomology, and imaging findings.
This paper references
10.1111/j.1468-2982.2006.01184.x
SMART: Stroke-Like Migraine Attacks After Radiation Therapy
D. F. Black (2006)
10.1093/NEUONC/5.2.121
Reversible, strokelike migraine attacks in patients with previous radiation therapy.
J. Bartleson (2003)
10.1016/j.clineuro.2011.06.009
Perfusion computer tomography helps to differentiate seizure and stroke in acute setting
Chuh-Hyoun Lie (2011)
10.3174/ajnr.A3602
Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome Is Not Always Completely Reversible: A Case Series
D. F. Black (2013)
10.1007/s00234-011-0946-z
Perfusion-weighted MR imaging in persistent hemiplegic migraine
I. Mourand (2011)
10.1007/s00234-015-1567-8
Susceptibility-weighted imaging in stroke-like migraine attacks after radiation therapy syndrome
Sara Khanipour Roshan (2015)
10.1212/01.wnl.0000228862.76269.62
Episodic neurologic dysfunction with migraine and reversible imaging findings after radiation
A. Pruitt (2006)
Krecke KN, O’neill BP: Reversible, stroke-like migraine attacks in patients with previous radiation therapy
JD Bartleson (2003)
10.1111/j.1468-1331.2009.02869.x
Cerebral perfusion‐CT patterns following seizure
J. M. Gelfand (2010)
10.1097/RLU.0b013e3181e4db6f
Normal Cerebrovascular Reactivity in Stroke-Like Migraine Attacks After Radiation Therapy Syndrome
K. Farid (2010)
10.1097/RLU.0b013e31826c0cf1
Impact of 99mTc-HMPAO brain perfusion scan in the diagnosis of hemiplegic migraine.
J. Jiménez-Hoyuela (2013)
Caplan's Stroke: A Clinical Approach
L. Caplan (2000)
10.4103/0972-2327.168634
Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome
R. S. Ramanathan (2016)
10.1016/j.clineuro.2012.08.012
Reversible CT perfusion abnormalities in patient with migraine variant: A two phase process
L. Shah (2013)
10.1212/WNL.0000000000002400
Cerebral perfusion in stroke-like migraine attacks after radiation therapy syndrome
Abby L Olsen (2016)



Semantic Scholar Logo Some data provided by SemanticScholar