SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients.
SMART syndrome (stroke-like migraine attacks after radiation therapy) is a rare condition that involves complex migraines with focal neurologic findings in patients following cranial irradiation for central nervous system malignancies. Little is known about the mechanisms behind the disorder, making successful treatment challenging. We report 2 new cases of SMART syndrome in pediatric patients as well as review all documented cases of the syndrome. Each of our 2 pediatric patients suffered multiple episodes. Attacks were characterized by severe headache, visual disturbance, aphasia, and weakness. Recovery occurred over several days to weeks. The data from all documented reports of SMART syndrome indicate a greater prevalence for male gender. An age-dependent pattern of onset was also observed, with a greater variability of syndrome onset in patients who received cranial irradiation at a younger age. SMART appears to be a reversible, recurrent long-term complication of radiation therapy with possible age- and gender-related influences.
1University of Connecticut School of Medicine, Farmington, CT, USA.
Amy E
AE
Armstrong
Eileen
E
Gillan
Francis Joseph
FJ
DiMario
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000528:radiation effects; D016543:Central Nervous System Neoplasms / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011878:Radiotherapy / Q000009:adverse effects*; D012737:Sex Factors; D013577:Syndrome; D055815:Young Adult
migraine; primary brain tumor; radiation therapy; stroke