Be Smart to Identify the Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome

Meari Taguchi,Anza B Memon,Kyle Bonner

doi:10.7759/cureus.21930

Abstract

Stroke-like migraine attacks after radiation therapy (SMART) are uncommon, often occurring years or decades after brain radiation therapy. This syndrome is a diagnosis of exclusion, and only about 40 cases describing SMART have been published, each one describing a constellation of symptoms and findings. Because symptoms can arise years after initial radiation therapy, the ability of physicians to recognize SMART and rule out other possible causes of symptoms is critical for the long-term care of oncology patients who have undergone cranial radiation. Here we present the case of a 55-year-old man who experienced SMART nine years after radiation therapy and who was successfully treated with steroids.

Highlights

Stroke-like migraine attacks after radiation therapy (SMART) syndrome was initially described by Shuper et al in 1995
SMART may manifest with a range of reversible signs and symptoms that are related to unilateral cortical regions, such as confusion, seizures, aphasia, visual-spatial deficits, hemisensory deficits, headache, or antecedent migraine with or without aura [1,3]
SMART syndrome has been reported in approximately 100 case reports, yet no consensus regarding the pathophysiology behind the syndrome or proper treatment exists [3]

Summary

Introduction

Stroke-like migraine attacks after radiation therapy (SMART) syndrome was initially described by Shuper et al in 1995. Black’s modified diagnostic criteria emphasize several main characteristics, including that the history of external beam cranial irradiation be “remote" While this term was not defined, the time intervals between radiation treatment and SMART in Black’s case series ranged from 1.2 to 21 years. SMART syndrome has been reported in approximately 100 case reports, yet no consensus regarding the pathophysiology behind the syndrome or proper treatment exists [3] In this case report, we describe a patient who presented with visual changes and right-sided weakness nine years after initial radiation therapy for medulloblastoma. We describe a patient who presented with visual changes and right-sided weakness nine years after initial radiation therapy for medulloblastoma This case highlights a diagnostic progression to SMART syndrome that can serve as a template for physicians who may encounter this rare pathology. Reference Range and Units

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Discussion

Conclusions

Disclosures