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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

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

Status Epilepticus in Patients with SMART (P5.012)
CONCLUSIONS We describe three patients with SMART presenting with SE. Our cases raise the concern that SMART is not necessarily a migraine phenomenon but can be a form of focal SE associated with stroke-like symptoms. In patients with radiographic suspicion of SMART we suggest a low threshold for vEEG monitoring and aggressive anti-epileptic management.Disclosure: Dr. Fan has nothing to disclose. Dr. Gabriel has nothing to disclose. Dr. Gerard has nothing to disclose. Dr. Schuele has received personal compensation for activities with Sunovion and Eisai as a speaker.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Fan, P., Gabriel, H., Gerard, E., Schuele, S. Tags: Neuromuscular Disease and Epilepsy ePoster Session Source Type: research

Cerebral perfusion in stroke-like migraine attacks after radiation therapy syndrome
We present 2 patients with recurrent attacks of SMART syndrome with increased cerebral blood volume in affected regions and abnormal vascular reactivity on transcranial Doppler ultrasound, suggesting a potential mechanism.
Source: Neurology - February 22, 2016 Category: Neurology Authors: Olsen, A. L., Miller, J. J., Bhattacharyya, S., Voinescu, P. E., Klein, J. P. Tags: MRI, All Clinical Neurology, All Cerebrovascular disease/Stroke, Radiation therapy-tumor CLINICAL/SCIENTIFIC NOTES 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

Recurrent stroke in childhood cancer survivors
Conclusion: Survivors of childhood cancer, particularly those previously treated with high-dose cranial radiation, have a high risk of recurrent stroke for decades after a first stroke. Although these strokes are mostly occurring in young adulthood, hypertension, an established atherosclerotic risk factor, independently predicts recurrent stroke in this population.
Source: Neurology - September 21, 2015 Category: Neurology Authors: Fullerton, H. J., Stratton, K., Mueller, S., Leisenring, W. W., Armstrong, G. T., Weathers, R. E., Stovall, M., Sklar, C. A., Goldsby, R. E., Robison, L. L., Krull, K. R. Tags: Childhood stroke, Stroke in young adults, All Cerebrovascular disease/Stroke, Primary brain tumor ARTICLE 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

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

Acute late-onset encephalopathy after radiotherapy: An unusual life-threatening complication
Unusual late-onset complications of brain irradiation, characterized by reversible neurologic focal signs, seizures, and MRI alterations, have recently been reported and classified as stroke-like migraine attacks after radiation therapy (SMART)1 and peri-ictal pseudoprogression (PIPG).2
Source: Neurology - September 9, 2013 Category: Neurology Authors: Di Stefano, A. L., Berzero, G., Vitali, P., Galimberti, C. A., Ducray, F., Ceroni, M., Bastianello, S., Colombo, A. A., Simoncelli, A., Brunelli, M. C., Giometto, B., Diamanti, L., Gaviani, P., Salmaggi, A., Silvani, A., Marchioni, E. Tags: All Clinical Neurology, Coma CLINICAL/SCIENTIFIC NOTES Source Type: research

SMART Syndrome (Stroke-Like Migraine Attacks after Radiation Therapy) in Adult and Pediatric Patients (P03.007)
CONCLUSIONS: SMART syndrome appears to be a reversible and recurrent long term complication of cranial irradiation. A review of the data indicates that age and gender may play a role in the development of the disease. Additionally, we postulate other mechanisms of SMART syndrome including possible genetic and hormonal influences.Disclosure: Dr. Armstrong has nothing to disclose. Dr. DiMario has received personal compensation for activities with E-Pocrates.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Armstrong, A., DiMario, F. Tags: P03 Child Neurology II Source Type: research