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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

SMART Syndrome Identification and Successful Treatment
We report a 41-year-old male patient admitted to our emergency room with a reduced level of consciousness and global aphasia. One month prior to admission, he started with frequent headache attacks of moderate intensity and paroxysmal behavioral alterations, advancing to confusion, gait instability, language impairment, and somnolence. He had a history of medulloblastoma treated with surgical resection followed by craniospinal irradiation 21 years before symptom onset. After excluding more frequent causes for the patient ’s symptoms along with a suggestive image pattern, we started treatment for SMART syndrome with high-...
Source: Case Reports in Neurology - January 25, 2021 Category: Neurology 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

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

Clinical Reasoning: A 68-year-old man with a history of lung cancer presenting with right-sided weakness and aphasia
A 68-year-old man with paroxysmal atrial fibrillation on warfarin, left subclavian thrombosis treated with carotid-subclavian bypass, and lung adenocarcinoma treated with pneumonectomy, chemotherapy, and prophylactic cranial irradiation and in remission since 1987 was admitted to our neurocritical care unit with acute onset of right-sided weakness, expressive aphasia, and lethargy. On admission his temperature was 101.7°F, and initial blood pressure was 140/60 mm Hg. There was no nuchal rigidity. He was alert and mute with impaired comprehension. He had left gaze preference. Vision was impaired in the right field. Ther...
Source: Neurology - October 5, 2015 Category: Neurology Authors: Gupta, A., Etherton, M. R., McKee, K., Baker, J. M., Izzy, S., Feske, S. K. Tags: All Cerebrovascular disease/Stroke, Radiation therapy-tumor, All Epilepsy/Seizures RESIDENT AND FELLOW SECTION Source Type: research

Refractory status epilepticus due to SMART syndrome
Conclusions Taking into account clinical evolution and ictal neuroimaging studies, status epilepticus could explain the origin of these episodes in SMART syndrome. Although most patients have reversible symptoms, in some cases, aggressive treatment to avoid sequelae is needed. This article is part of a Special Issue entitled “Status Epilepticus”.
Source: Epilepsy and Behavior - June 12, 2015 Category: Neurology Source Type: research

Refractory status epilepticus due to SMART syndrome.
CONCLUSIONS: Taking into account clinical evolution and ictal neuroimaging studies, status epilepticus could explain the origin of these episodes in SMART syndrome. Although most patients have reversible symptoms, in some cases, aggressive treatment to avoid sequelae is needed. This article is part of a Special Issue entitled "Status Epilepticus". PMID: 26071996 [PubMed - as supplied by publisher]
Source: Epilepsy and Behaviour - June 11, 2015 Category: Neurology Authors: Jaraba S, Puig O, Miró J, Velasco R, Castañer S, Rodríguez L, Izquierdo C, Simó M, Veciana M, Falip M Tags: Epilepsy Behav 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

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

Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome Is Not Always Completely Reversible: A Case Series FELLOWS' JOURNAL CLUB
SUMMARY: We retrospectively reviewed clinical and imaging findings in 11 patients with stroke-like migraine attacks after radiation therapy (SMART) syndrome to better understand this disorder previously thought to be reversible. Six men and 5 women had complex bouts of neurologic impairment beginning, on average, 20 years after cerebral irradiation. All had characteristic, unilateral gyriform enhancement on MR imaging that developed within 2–7 days and typically resolved in 2–5 weeks. Unlike prior reports, 45% had incomplete neurologic recovery manifesting as dysphasia, cognitive impairment, or hemiparesis. The...
Source: American Journal of Neuroradiology - December 13, 2013 Category: Radiology Authors: Black, D. F., Morris, J. M., Lindell, E. P., Krecke, K. N., Worrell, G. A., Bartleson, J. D., Lachance, D. H. Tags: FELLOWS ' JOURNAL CLUB Source Type: research

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