title: Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series.
abstract: 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.
authors.affiliation: Departments of Radiology.
authors.forename: D F
authors.initials: DF
authors.lastname: Black
authors.forename: J M
authors.initials: JM
authors.lastname: Morris
authors.forename: E P
authors.initials: EP
authors.lastname: Lindell
authors.forename: K N
authors.initials: KN
authors.lastname: Krecke
authors.forename: G A
authors.initials: GA
authors.lastname: Worrell
authors.forename: J D
authors.initials: JD
authors.lastname: Bartleson
authors.forename: D H
authors.initials: DH
authors.lastname: Lachance
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D020127:Recovery of Function; D012074:Remission Induction; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D013577:Syndrome; D016896:Treatment Outcome