SMART syndrome, a catchy acronym for the otherwise unwieldy stroke-like migraine attacks after radiation therapy, is an uncommon delayed complication of cerebral radiation therapy.
Patients usually present years after radiation therapy with prolonged stroke-like episodes with associated neurological dysfunction. These episodes have associated headache and are often preceded by an migraine-like aura 1-2. Occasionally patients may also present with seizures.
The hallmark of SMART syndrome is prominent and transient gyral enhancement. It`s also observed a cortical thickening (hyperintense in T2 and FLAIR) with diffusion restriction.
In a few cases may have laminar necrosis.
Treatment and prognosis
Typically the condition is self limiting, and gradually resolves over the course of several weeks 4.
- prolonged seizure activity
- cerebral infarction (subacute)
- direct remote effects of radiation
- prolonged complicated migraine
- 1. Caplan LR. Caplan's Stroke, A Clinical Approach. Saunders. (2009) ISBN:1416047212. Read it at Google Books - Find it at Amazon
- 2. Bartleson JD, Krecke KN, O'neill BP et-al. Reversible, strokelike migraine attacks in patients with previous radiation therapy. Neuro-oncology. 2003;5 (2): 121-7. doi:10.1215/S1522-8517-02-00040-6 - Free text at pubmed - Pubmed citation
- 3. Kerklaan JP, Lycklama á nijeholt GJ, Wiggenraad RG et-al. SMART syndrome: a late reversible complication after radiation therapy for brain tumours. J. Neurol. 2011;258 (6): 1098-104. doi:10.1007/s00415-010-5892-x - Free text at pubmed - Pubmed citation
- 4. Bradshaw J, Chen L, Saling M et-al. Neurocognitive recovery in SMART syndrome: a case report. Cephalalgia. 2011;31 (3): 372-6. doi:10.1177/0333102410388436 - Pubmed citation
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