SMART syndrome

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. 

Clinical presentation

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. 

Radiographic features


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.

Treatment and prognosis

Typically the condition is self limiting, and gradually resolves over the course of several weeks 4

Differential diagnosis

  • prolonged seizure activity
  • cerebral infarction (subacute)
  • direct remote effects of radiation
  • prolonged complicated migraine
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Article Information

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