Presentation
Presented with cortical blindness and new onset confusion. Background history of previous medulloblastoma resection with radiation therapy (30 years prior).
Patient Data
Cortical thickening and increased T2/FLAIR signal accompanied by serpiginous cortical enhancement involving predominantly the posterior temporal, parietal and occipital lobes bilaterally. Scattered micro-hemorrhages on SWI likely due to previous radiation therapy. Post-surgical changes seen in the posterior fossa.
Case Discussion
This is a possible case of SMART syndrome given the background history and prominent gyral enhancement. It is, however, somewhat atypical as imaging findings are usually unilateral 1,2. Furthermore, the absence of headaches/migraines is also atypical. Follow-up imaging has not been provided to ascertain if these changes resolved.
Other differentials such as PRES should also be considered (though this patient was not hypertensive).
Thank you to Dr Han Xin Lau for contributing this case with me.
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