SMART Syndrome

Case contributed by Dr Hernán Walter Brouver de Koning

Presentation

History of meningioma resection 20 years ago and treated with radiotherapy. Headache and visual disturbances of 3 weeks of evolution

Patient Data

Age: 55 years
Gender: Female
MRI

Prominent right occipital and parietal lobes cortical thickening and hyperintensity on axial FLAIR and T2 image with gyriform enhancement on T1W image after gadolinium administration without respecting vascular territories. No diffusion restriction.

Biparietal postsurgical encephalomalacia.

Case Discussion

In this context, the findings are considered compatible with SMART syndrome (stroke-like migraine attacks after radiation therapy). SMART syndrome is an infrequent late complication of radiation therapy that has been linked to microvascular dysfunction.

Symptoms and brain MRI abnormalities tend to be transient. 

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