Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome

Ramnath Santosh Ramanathan; Gayathri Sreedher; Konark Malhotra; Zain Guduru; Deeksha Agarwal; Mary Flaherty; Timothy Leichliter; Sandeep Rana

doi:10.4103/0972-2327.168634


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CASE REPORT

Year : 2016 | Volume : 19 | Issue : 3 | Page : 399-401

Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome

Ramnath Santosh Ramanathan¹, Gayathri Sreedher², Konark Malhotra³, Zain Guduru³, Deeksha Agarwal³, Mary Flaherty³, Timothy Leichliter⁴, Sandeep Rana⁵
¹ Department of Neurology, Neurology Chief Resident, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
² Pediatric Neuro-Radiology, Akron Childrens Hospital, Akron, Ohio, United States
³ Department of Neurology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
⁴ Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
⁵ Associate Professor of Neurology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States

Correspondence Address:
Ramnath Santosh Ramanathan
420 East North Ave, Suite 206, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania-15212
United States

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0972-2327.168634

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.

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