title: Surgically induced SMART syndrome: case report and review of the literature.
abstract: BACKGROUND
  Strokelike migraine attack after radiation therapy is a recently described clinical entity characterized by transient hemispheric dysfunction manifesting as, but not limited to, visuospatial deficits, confusion, hemisensory deficits, hemiparesis, aphasia, seizures, and, most prominently, headache in patients with a history of remote external beam radiation therapy to the brain. The radiographic hallmark on magnetic resonance imaging is the presence of transient, diffuse, unilateral gadolinium enhancement of the cortex with white matter sparing, usually corresponding to the previous radiation field.
  
  
  METHODS
  We present a case of strokelike migraine attacks after radiation therapy syndrome diagnosed immediately following a craniotomy and temporal lobectomy for recurrent metastatic tumor resection after prior gamma knife radiosurgery and whole-brain radiation therapy.
  
  
  CONCLUSIONS
  SMART syndrome should be considered in the differential diagnosis of postsurgical patients with remote history of cranial irradiation and significant, new transient neurologic deficits not explainable by any other mechanism. It is possible that manipulation of the trigeminal ganglion, or the dura of the Meckel cave, contributed to triggering the manifestations of this syndrome in our patient during the immediate postoperative period.
authors: Department of Neurosurgery, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA.
authors: Patrick R
authors: PR
authors: Maloney
authors: Department of Neurology, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA.
authors: Alejandro A
authors: AA
authors: Rabinstein
authors: Department of Neurosurgery, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA.
authors: David J
authors: DJ
authors: Daniels
authors: Department of Neurosurgery, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA. Electronic address: link.michael@mayo.edu.
authors: Michael J
authors: MJ
authors: Link
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D038481:Anterior Temporal Lobectomy; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D009422:Nervous System Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011832:Radiation Injuries / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery / Q000009:adverse effects; D013577:Syndrome
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: Radiation; SMART syndrome; Trigeminovascular system