title: Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome.
abstract: Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of cerebral radiation therapy. A 53-year-old female initially presented with headache, confusion and left homonymous hemianopia. Her medical history was notable for cerebellar hemangioblastoma, which was treated with radiation in 1987. Her initial brain MRI (magnetic resonance imaging) revealed cortical enhancement in the right temporo-parieto-occipital region. She improved spontaneously in 2 weeks and follow-up scan at 4 weeks revealed no residual enhancement or encephalomalacia. She presented 6 weeks later with aphasia. Her MRI brain revealed similar contrast-enhancing cortical lesion but on the left side. Repeat CSF studies was again negative other than elevated protein. She was treated conservatively and recovered completely within a week. Before diagnosing SMART syndrome, it is important to rule out tumor recurrence, encephalitis, posterior reversible encephalopathy syndrome (PRES) and stroke. Typically the condition is self-limiting, and gradually resolves.
authors: Department of Neurology, Neurology Chief Resident, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Ramnath Santosh
authors: RS
authors: Ramanathan
authors: Pediatric Neuro-Radiology, Akron Childrens Hospital, Akron, Ohio, United States.
authors: Gayathri
authors: G
authors: Sreedher
authors: Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Konark
authors: K
authors: Malhotra
authors: Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Zain
authors: Z
authors: Guduru
authors: Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Deeksha
authors: D
authors: Agarwal
authors: Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Mary
authors: M
authors: Flaherty
authors: Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Timothy
authors: T
authors: Leichliter
authors: Associate Professor of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
authors: Sandeep
authors: S
authors: Rana
keywords: Migraines; SMART syndrome; radiation therapy