Normal cerebrovascular reactivity in Stroke-like Migraine Attacks after Radiation Therapy syndrome.
Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome is a rare complication of cranial irradiation. Radiation is well-known to impair vascular vessel architecture and function. We investigated the hypothesis of radiation-induced cerebral vascular reserve dysfunction as the underlying mechanism of SMART. Interictal cerebrovascular reactivity was investigated using Tc-99m hexamethylpropyleneamine oxime-SPECT and acetazolamide challenge in 3 patients. We found interictal hypoperfusion and normal cerebrovascular reactivity in all patients. Neither ictal restriction of the apparent diffusion coefficient nor MR angiography abnormalities were observed. These findings do not support a vascular mechanism in SMART syndrome. Postradiation neuronal dysfunction may be the underlying mechanism. Further investigations on larger series are needed to confirm this hypothesis.
Farid
Karim
K
CHU de Bordeaux, Service de Médecine Nucléaire, Bordeaux, France. kwfarid@hotmail.com
Meissner
Wassilios G
WG
Samier-Foubert
Alexandra
A
Barret
Olivier
O
Menegon
Patrice
P
Rouanet
François
F
Fernandez
Philippe
P
Orgogozo
Jean Marc
JM
Allard
Michèle
M
Tison
François
F
Sibon
Igor
I
D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D011878:Radiotherapy / Q000009:adverse effects*; D020521:Stroke; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult