Early-onset stroke-like migraine attacks after radiation therapy syndrome: A case report and review of the literature

• Published in: Journal of clinical neuroscience 2024-12, Vol.132, p.110983, Article 110983
• Main Authors: Chow, Ariana, Hovis, Gabrielle E.A., Ghodrati, Farinaz, Harary, Maya, Mozaffari, Khashayar, Pradhan, Anjali, Hegde, John, Yang, Isaac
• Format: Article
• Language: English
• Subjects: Brain radiation; Delayed onset; SMART syndrome; Stereotactic radiosurgery; Stroke-like migraine attacks after radiation therapy
• ISSN: 0967-5868; 1532-2653; 1532-2653
• DOI: 10.1016/j.jocn.2024.110983

•SMART syndrome describes a presentation of migraines, seizures, and stroke-like symptoms following brain irradiation.•The most frequent presenting symptoms include headache, aphasia, and unilateral hemiparesis.•SMART syndrome typically presents within 2-10 years after initial radiation but may present within one year.•SMART syndrome has previously been reported with fractionated radiotherapy but may also follow single-fraction SRS.•Complete resolution may be expected in 36% of patients diagnosed with SMART syndrome. Stroke-like migraine attacks after radiation therapy (SMART) syndrome is characterized by migraines, seizures, and stroke-like symptoms following brain irradiation. Diagnosis consists of clinical signs, history of brain irradiation, and radiographic evaluation. The latency to onset varies widely among individual patients, ranging from 1 to 35 years. Herein, we review the literature and present a case of SMART syndrome with an onset of five months after stereotactic radiosurgery for a benign meningioma. A systematic review of the literature was conducted in line with the PRISMA guidelines. The PubMed, Cochrane, and Web of Science databases were searched for cases of SMART syndrome with reported time of onset and radiation dosage. Finally, we report the presentation, history, radiographic findings, and clinical outcomes of a 48-year-old female with suspected SMART syndrome. Of 101 articles reviewed, 23 articles were selected for inclusion in the present study. A total of 27 cases were identified. The mean age at presentation was 43 years (range: 11–70), and 71.4 % of patients were male. The mean latency to onset was 11.2 years after radiation. Based on case descriptions, none of the patients were definitively treated with single fraction radiosurgery. SMART syndrome may present with variations in latency to onset, radiation dose, outcome, and clinical course. The present case of SMART syndrome highlights the variety in clinical presentation of this disease. Further work should be considered to better determine whether clinical and radiographic criteria for diagnosing SMART syndrome diagnosis are sufficient to encompass patients with a non-traditional presentation.