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SMART Syndrome (Stroke-like migraine attacks after radiation therapy): When to suspect it?
CONCLUSION: The triad of migraine, seizure, and hemiparesis within the context of a prior brain radiotherapy should promptly raise the suspicion of SMART syndrome. Prompt diagnosis is essential to avoid unnecessary invasive investigations.PMID:34877047 | PMC:PMC8645481 | DOI:10.25259/SNI_893_2021
Source: Surgical Neurology International - December 8, 2021 Category: Neurosurgery Authors: Petros Angelidis Christian Saleh Phillip Jaszczuk Muhannad Seyam Katarina Alexandra Ebner Margret Hund-Georgiadis Source Type: research

Moyamoya Disease Associated with Asymptomatic Mosaic Turner Syndrome: A Rare Cause of Hemorrhagic Stroke
We present the first reported case of an adult patient with previously unrecognized mosaic Turner syndrome with acute subarachnoid and intracerebral hemorrhage as the initial manifestation of moyamoya syndrome. A 52-year-old woman was admitted with a subarachnoid hemorrhage with associated flame-shaped intracerebral hemorrhage in the left frontal lobe. Physical examination revealed short stature, pectus excavatum, small fingers, micrognathia, and mild facial dysmorphism. Cerebral angiography showed features consistent with bilateral moyamoya disease, aberrant intrathoracic vessels, and an unruptured 4-mm right superior hyp...
Source: Journal of Stroke and Cerebrovascular Diseases - October 7, 2013 Category: Neurology Authors: Sunil Manjila, Benjamin R. Miller, Anitha Rao-Frisch, Balint Otvos, Anna Mitchell, Nicholas C. Bambakidis, Michael A. De Georgia Tags: Case Reports Source Type: research

SMART syndrome: Stroke-like migraine attack after radiation therapy
A 57-year-old woman presented with intense headache 13 years after cranioplasty and radiation treatment for occipital osteosarcoma. Examination showed anomia and paraphasic errors, right homonymous hemianopia, and dysmetria of the right arm. MRI during hospitalization demonstrated diffuse pathologic enhancement in the left parieto-occipital lobe (figure, A) and extensive gyral edema (figure, B and C). EEG while she was symptomatic showed left-predominant posterior quadrant slowing without epileptiform abnormalities. She was diagnosed with stroke-like migraine attacks after radiation therapy (SMART) syndrome and treated wit...
Source: Nature Clinical Practice - December 8, 2014 Category: Neurology Authors: Wang, N., Prasad, S. Tags: All Headache, MRI, Radiation therapy-tumor Cases Source Type: research

The Syndrome of Stroke-like Migraine Attacks After Radiation Therapy Associated With Prolonged Unresponsiveness in an Adult Patient
Conclusions: Reduced level of consciousness of such severity and duration as observed here has not previously been described in SMART syndrome. This report, however, suggests that an excellent prognosis can be expected even in cases of prolonged unresponsiveness. The pathogenic mechanisms of SMART syndrome remain unclear, but may involve pathways common to both migraine and epilepsy.
Source: The Neurologist - January 1, 2015 Category: Neurology Tags: Case Report/Case Series Source Type: research

Teaching NeuroImages: Radiation-associated symptomatic carotid artery disease with ipsilateral radiodermatitis
A 68-year-old man with a history of squamous cell carcinoma of the tongue treated with external beam radiation therapy in 2007 presented in 2013 with acute onset expressive aphasia and right lower facial weakness. MRI confirmed an acute infarct in the left frontal cortex. CT angiography revealed occlusion vs critical stenosis of the left internal carotid artery, new from 2007. Examination of the patient's neck revealed ipsilateral radiodermatitis (figure). Therapeutic neck irradiation has been associated with accelerated atheromatous disease, carotid artery stenosis, and increased risk of stroke.1,2 Ipsilateral radiodermat...
Source: Neurology - February 2, 2015 Category: Neurology Authors: Ehrlich, M. E., Gulvezan, T., Southerland, A. M. Tags: All Imaging, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

High-resolution MRI of radiation-induced intracranial vasculopathy
A 46-year-old woman without traditional stroke risk factors presented with acute left limbs numbness. Two years prior, she had a right cranio-orbital junction meningioma resected and received radiation therapy (target dose DT 60 Gy/30 F, 5 F/W, 2 Gy/F). MRI revealed a diffusion-positive focus within the anterior periventricular white matter. CT angiography showed >50% right middle cerebral artery (MCA) stenosis. High-resolution MRI (HRMRI) suggested concentric vessel wall thickening with contrast enhancement (figure).
Source: Neurology - February 9, 2015 Category: Neurology Authors: Li, M., Wu, S.-W., Xu, W.-H. Tags: All Clinical Neurology, Fungal infections, All Cerebrovascular disease/Stroke NEUROIMAGES Source Type: research

Susceptibility-weighted imaging in stroke-like migraine attacks after radiation therapy syndrome
Conclusion These preliminary findings suggest that SWI may help identify SMART syndrome or at least help discriminate it from other disorders, by the findings of numerous susceptibility hypointensities on SWI likely representing RICHs, gyriform enhancement on T1WI, and postsurgical findings or appropriate clinical history.
Source: Neuroradiology - August 5, 2015 Category: Radiology Source Type: research

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 RanaAnnals of Indian Academy of Neurology 2016 19(3):399-401Stroke-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 te...
Source: Annals of Indian Academy of Neurology - July 24, 2016 Category: Neurology Authors: Ramnath Santosh Ramanathan Gayathri Sreedher Konark Malhotra Zain Guduru Deeksha Agarwal Mary Flaherty Timothy Leichliter Sandeep Rana Source Type: research

Stroke After Radiation Therapy for Head and Neck Cancer: What Is the Risk?
A retrospective population-based cohort study was conducted to determine the risk of ischemic stroke with respect to time, associated with curative radiation therapy in head and neck squamous cell carcinomas (HNSCC).
Source: International Journal of Radiation Oncology * Biology * Physics - July 15, 2016 Category: Radiology Authors: Erin Arthurs, Timothy P. Hanna, Khaled Zaza, Yingwei Peng, Stephen F. Hall Tags: Clinical Investigation Source Type: research

Clinical Reasoning: Corpus callosum lesion with multiple strokes
A 71-year-old woman with hypertension, diabetes, and recent stroke presented with acute left hemiparesis, which started 3.5 hours earlier but improved by the time of emergency department evaluation. Examination showed mild left-sided pronator drift and sensory extinction. Her history was significant for resection of a right frontoparietal meningioma for which she had received adjuvant radiation therapy 3 years previously.
Source: Neurology - April 3, 2017 Category: Neurology Authors: Sheikh, Z., Anadani, N., Raval, B., Sharer, L., Hillen, M. Tags: MRI, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Stroke like migraine attacks after radiation therapy (SMART) syndrome a case series of three patients (P6.179)
Conclusions:Our patients represent the first case series of SMART syndrome in a single institution. Our cases share similarities to the prior reports in the literature and highlights the clinical and MRI triad of acute onset headaches, neurological deficits and MRI findings of transient contrast enhancement of the cortex with white matter sparing in a previous radiation field.Disclosure: Dr. rauf has nothing to disclose. Dr. Boulter has nothing to disclose. Dr. Imitola has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Rauf, Y., Boulter, D., Imitola, J. Tags: Neurologic Complications of Cancer Source Type: research

Stroke ‐like migraine attacks after radiation therapy: A misnomer?
Summary ObjectiveTo understand the frequency of electrographic and clinical seizures in patients with stroke‐like migraine attacks after radiation therapy (SMART), and determine whether SMART warrants comprehensive electroencephalographic (EEG) monitoring and aggressive seizure management. MethodsWe searched our magnetic resonance brain imaging report database for all patients between January 2013 and December 2015 for suspected SMART syndrome. Clinical inclusion criteria were further applied as follows: inpatient adults (>18 years of age) with history of cranial radiation presenting with acute neurologic deficits as ...
Source: Epilepsia - November 23, 2017 Category: Neurology Authors: Emily Peien Fan, Gabriel Heiber, Elizabeth E. Gerard, Stephan Schuele Tags: FULL ‐LENGTH ORIGINAL RESEARCH Source Type: research

Genetic variant linked to increased stroke risk in childhood cancer survivors treated with CRT
(American Association for Cancer Research) A common single nucleotide polymorphism (SNP) was associated with increased risk for developing stroke in childhood survivors who received cranial radiation therapy (CRT) for their primary cancer, according to results presented at the AACR Annual Meeting 2019, March 29-April 3.
Source: EurekAlert! - Cancer - April 2, 2019 Category: Cancer & Oncology Source Type: news

Stroke and thromboembolic events in men with prostate cancer treated with definitive radiation therapy with or without androgen deprivation therapy
Stroke and thromboembolic events in men with prostate cancer treated with definitive radiation therapy with or without androgen deprivation therapy, Published online: 15 April 2019; doi:10.1038/s41391-019-0150-5Stroke and thromboembolic events in men with prostate cancer treated with definitive radiation therapy with or without androgen deprivation therapy
Source: Prostate Cancer and Prostatic Diseases - April 14, 2019 Category: Urology & Nephrology Authors: Rishi Deka Daniel R. Simpson Matthew S. Panizzon Richard L. Hauger Paul Riviere Vinit Nalawade Rana McKay James D. Murphy Brent S. Rose Source Type: research

Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Rare, Reversible Complication of Radiation Therapy.
PMID: 32202326 [PubMed - as supplied by publisher]
Source: Headache - March 22, 2020 Category: Neurology Authors: Makar GS, Siegal T, Syrow L Tags: Headache Source Type: research