SMART syndrome

A.Prof Frank Gaillard et al.

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 as cortical thickening (hyperintense in T2 and FLAIR) with or without diffusion restriction. 

In a few cases there may be laminar necrosis.

Susceptibility-weighted imaging (SWI) typically demonstrates multiple microhemorrhagic foci, thought related to sequelae of remote radiation therapy.

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
Share article

Article information

rID: 10753
Section: Syndromes
Synonyms or Alternate Spellings:
  • Stroke-like migraine attacks after radiation therapy

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Updating… Please wait.

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.