PP04.4 – 2897: SMART syndrome: A rare complication of cranial radiotherapy

Abstract

Objective SMART syndrome (stroke-like migraine attacks after radiation therapy) is a rare complication of cranial radiotherapy characterized by migraine-like headache and transient neurological deficits with typical gyriform enhancement on magnetic resonance imaging (MRI). Little is known about the pathophysiology of this condition. Potential underlying mechanisms are endothelial damage or dysfunction, vascular instability, vasospasm and, neuronal dysfunction. Patients We report an 11-year-old girl with primary diagnosis of medulloblastoma presented with acute-onset severe headache and left sided weakness 20 months after completion of cranial radiotherapy. MRI demonstrated unilateral cortical swelling and concomitant leptomeningeal, gyral contrast enhancement, and increased cortical perfusion in the right temporoparietooccipital region. Her symptoms resolved spontaneously over several days. Conclusion SMART syndrome appears to be a reversible and long-term complication of cranial radiotherapy. Up to now, a limited number of pediatric patients with SMART syndrome have been reported. Awareness and recognition of clinical signs and radiological imaging of SMART syndrome is important for preventing unnecessary interventions, appropriate diagnostic workup and management.