Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of cerebral radiation therapy. A 53-year-old female initially presented with headache, confusion and left homonymous hemianopia. Her medical history was notable for cerebellar hemangioblastoma, which...

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Bibliographic Details
Published in:Annals of the Indian Academy of Neurology 2016-07, Vol.19 (3), p.399-401
Main Authors: Ramanathan, Ramnath, Sreedher, Gayathri, Malhotra, Konark, Guduru, Zain, Agarwal, Deeksha, Flaherty, Mary, Leichliter, Timothy, Rana, Sandeep
Format: Article
Language:English
Subjects:
Care and treatment
Case Report
Causes of
Diagnosis
Health aspects
Migraine
Migraines
radiation therapy
Radiotherapy
SMART syndrome
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Summary:Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of cerebral radiation therapy. A 53-year-old female initially presented with headache, confusion and left homonymous hemianopia. Her medical history was notable for cerebellar hemangioblastoma, which was treated with radiation in 1987. Her initial brain MRI (magnetic resonance imaging) revealed cortical enhancement in the right temporo-parieto-occipital region. She improved spontaneously in 2 weeks and follow-up scan at 4 weeks revealed no residual enhancement or encephalomalacia. She presented 6 weeks later with aphasia. Her MRI brain revealed similar contrast-enhancing cortical lesion but on the left side. Repeat CSF studies was again negative other than elevated protein. She was treated conservatively and recovered completely within a week. Before diagnosing SMART syndrome, it is important to rule out tumor recurrence, encephalitis, posterior reversible encephalopathy syndrome (PRES) and stroke. Typically the condition is self-limiting, and gradually resolves.
ISSN:0972-2327
1998-3549
DOI:10.4103/0972-2327.168634