title: Brain Magnetic Resonance Spectroscopy Findings in the Stroke-like Migraine Attacks after Radiation Therapy (SMART) Syndrome.
abstract: A 41-year-old male presented with an acute onset of headache, confusion, seizures, and unilateral focal neurological deficit 25 years after receiving whole-brain radiation therapy to treat a cerebellar medulloblastoma. Brain magnetic resonance imaging (MRI) demonstrated a thick unilateral parieto-occipital cortical contrast enhancement. A diagnosis of "Stroke-like Migraine Attacks after Radiation Therapy" (SMART) syndrome was made. Here, we describe the brain MR spectroscopy findings of SMART, showing a decrease in N-acetyl-aspartate and increased levels of creatine and choline, corresponding with neuronal destruction or transient neuronal impairment with mild nonspecific gliosis. The absence of a lactate peak suggests that mitochondrial dysfunction, vasospasm or ischemic mechanisms were not involved.
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Gómez-Cibeira
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Calleja-Castaño
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez de la Aleja
authors.affiliation: Department of Neurology, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Sierra-Hidalgo
authors.affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz Morales
authors.affiliation: Department of Neurorradiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Salvador-Alvarez
authors.affiliation: Department of Neurorradiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ramos-Gonzalez
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D002528:Cerebellar Neoplasms / Q000532:radiotherapy; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy; D008881:Migraine Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*
keywords: Creatine; SMART; magnetic resonance spectroscopy; radiation therapy; stroke-like migraine attacks after radiation therapy