title: Stroke-like Migraine Attacks after Radiation Therapy Syndrome.
abstract: OBJECTIVE
  To summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of stroke-like migraine attacks after radiation therapy (SMART) syndrome, and to propose diagnostic criteria for this disorder.
  
  
  METHODS
  We searched the PubMed database for articles in English published from 1995 to 2015 using the terms of "stroke-like AND migraine AND radiation." Reference lists of the identified articles and reviews were used to retrieve additional articles.
  
  
  METHODS
  Data and articles related to late-onset effects of cerebral radiation were selected and reviewed.
  
  
  RESULTS
  SMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies. The recovery, which ranges from hours to days to weeks, can be partial or complete. We propose the following diagnostic criteria for SMART: (1) Remote history of therapeutic external beam cranial irradiation for malignancy; (2) prolonged, reversible clinical manifestations mostly years after irradiation, which may include migraine, seizures, hemiparesis, hemisensory deficits, visuospatial defect, aphasia, confusion and so on; (3) reversible, transient, unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region; (4) eventual complete or partial recovery, the length of duration of recovery ranging from hours to days to weeks; (5) no evidence of residual or recurrent tumor; (6) not attributable to another disease. To date, no specific treatment has been identified for this syndrome.
  
  
  CONCLUSIONS
  SMART is an extremely rare delayed complication of brain irradiation. However, improvements in cancer survival rates have resulted in a rise in its frequency. Hence, awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zheng
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Tan
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Qin
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
authors.forename: Hai-Nan
authors.initials: HN
authors.lastname: Zhang
mesh_terms: D016543:Central Nervous System Neoplasms / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis* / Q000209:etiology*; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis*; D020521:Stroke / Q000175:diagnosis*