Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series

We retrospectively reviewed clinical and imaging findings in 11 patients with stroke-like migraine attacks after radiation therapy (SMART) syndrome to better understand this disorder previously thought to be reversible. Six men and 5 women had complex bouts of neurologic impairment beginning, on ave...

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Published inAmerican journal of neuroradiology : AJNR Vol. 34; no. 12; pp. 2298 - 2303
Main Authors Black, D F, Morris, J M, Lindell, E P, Krecke, K N, Worrell, G A, Bartleson, J D, Lachance, D H
Format Journal Article
LanguageEnglish
Published United States American Society of Neuroradiology 01.12.2013
Subjects
Adult
Brain
Brain Injuries - diagnosis
Brain Injuries - etiology
Brain Neoplasms - complications
Brain Neoplasms - radiotherapy
Fellows' Journal Club
Female
Humans
Magnetic Resonance Imaging - methods
Male
Middle Aged
Migraine Disorders - diagnosis
Migraine Disorders - etiology
Prognosis
Radiation Injuries - diagnosis
Radiation Injuries - etiology
Radiotherapy - adverse effects
Recovery of Function
Remission Induction
Stroke - diagnosis
Stroke - etiology
Syndrome
Treatment Outcome
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Summary:We retrospectively reviewed clinical and imaging findings in 11 patients with stroke-like migraine attacks after radiation therapy (SMART) syndrome to better understand this disorder previously thought to be reversible. Six men and 5 women had complex bouts of neurologic impairment beginning, on average, 20 years after cerebral irradiation. All had characteristic, unilateral gyriform enhancement on MR imaging that developed within 2-7 days and typically resolved in 2-5 weeks. Unlike prior reports, 45% had incomplete neurologic recovery manifesting as dysphasia, cognitive impairment, or hemiparesis. The remaining 55% recovered completely over an average of 2 months. Three of 11 patients developed cortical laminar necrosis. Brain biopsies in 4 of 11 did not demonstrate a specific pathologic substrate. These additional 11 patients contribute to the understanding of variability in stroke-like migraine attacks after radiation therapy syndrome, which often but not uniformly manifests with headaches and seizures, demonstrates a typical evolution of imaging findings, and may result in permanent neurologic and imaging sequelae.
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ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A3602