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SMART syndrome with cerebral angiographic abnormalities - A case report
Black et al. first used the terminology ‘stroke-like migraine attacks after radiation therapy (SMART) syndrome’ and proposed diagnostic criteria in 2006 [1]. Proposed diagnostic criteria are remote history of cerebral radiotherapy, prolonged but reversible signs and symptoms referable to a unilateral cortical region and nearly reversi ble diffuse gyral and leptomeningeal enhancement within the symptomatic area [2]. However, these criteria do not include angiographic features. To the best of our knowledge, our case is the first report to show vascular change by means of digital subtraction angiography.
Source: Journal of the Neurological Sciences - August 22, 2017 Category: Neurology Authors: Ji-Hyung Park, Moo-seok Park, Gyeong-Moon Kim Tags: Letter to the Editor Source Type: research

Incidence of myocardial infarction and stroke in acromegaly patients: results from the German Acromegaly Registry
ConclusionsFor acromegaly patients being treated at specialized centres, the incidence of MIs and strokes does not seem to differ from the general population. Certainty regarding such statements requires large, prospective studies however.
Source: Pituitary - August 14, 2017 Category: Endocrinology Source Type: research

Ischemic stroke after radiation therapy for pituitary adenomas: a systematic review
In conclusion, complications of cerebral ischemia after radiotherapy for pituitary adenoma are infrequently reported. Moreover, after correction for several confounders, no significant difference in ischemic stroke rate between irradiated and non-irradiated patients could be identified.
Source: Journal of Neuro-Oncology - June 28, 2017 Category: Cancer & Oncology Source Type: research

Reversible hemispheric hypoperfusion in two cases of SMART syndrome
We present two cases demonstrating reversible hemispheric hypoperfusion. Case 1 presented with left hemispheric symptoms following previous similar episodes. CT perfusion (CTP) demonstrated reversible hemispheric hypoperfusion; subsequent investigations were consistent with SMART syndrome. Case 2 presented following the third episode of a hemispheric syndrome with near-identical CTP abnormalities. L-arginine was administered with rapid reversal of clinical and CTP abnormalities. We conclude that SMART syndrome may demonstrate significant hypoperfusion on hyperacute CTP without subsequent infarction. Impaired cerebrovascula...
Source: Journal of Clinical Neuroscience - June 21, 2017 Category: Neuroscience 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

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

A 15-year-old girl with acute and reversible neurologic symptoms after cranial irradiation for medulloblastoma
A 15-year-old girl with history of medulloblastoma was evaluated for headache and acute onset neurologic deficits 5 years after completion of initial radiation therapy and 3 years following completion of re-irradiation. Neurological examination was notable for new onset left hemianopia, hemiparesis and neglect. MRI showed extensive areas of cortical T2 prolongation and thickening involving the right parietal, occipital and temporal lobes, with associated extensive gyral enhancement. Upon spontaneous resolution of her weakness after 4 days, repeat MRI showed resolution of the edema and gyral enhancement, suggestive of the d...
Source: Seminars in Pediatric Neurology - April 1, 2017 Category: Neurology Authors: Elizabeth Duke, Nicole J Ullrich Source Type: research

A 15-Year-Old Girl With Sudden Onsent Reversible Neurologic Symptoms After Cranial Irradiation for Medulloblastoma
A 15-year-old girl with history of medulloblastoma was evaluated for headache and neurologic deficits 5 years after completion of initial radiation therapy and 3 years following completion of reirradiation. Neurologic examination was notable for new-onset left hemianopia, hemiparesis, and neglect. Magnetic resonance imaging showed extensive areas of cortical T2 prolongation and thickening involving the right parietal, occipital, and temporal lobes with associated extensive gyral enhancement. Upon spontaneous resolution of her weakness after 4 days, repeat magnetic resonance imaging showed resolution of the edema and gyral ...
Source: Seminars in Pediatric Neurology - April 1, 2017 Category: Neurology Authors: Elizabeth Duke, Nicole J. Ullrich Source Type: research

Updates in outcomes of stereotactic radiation therapy in acromegaly
Conclusion Although the use of radiotherapy in patients with acromegaly has decreased with advances in medical treatments, it remains an effective treatment option after unsuccessful surgery and/or resistance or unavailability of medical therapy. Long-term studies evaluating secondary morbidity and mortality rate after the new stereotactic techniques are needed, in order to evaluate their potential brain-sparing effect.
Source: Pituitary - February 15, 2017 Category: Endocrinology Source Type: research

In Regard to Arthurs et  al
To the Editor: Arthurs et  al (1) present another large database analysis, this one focusing on the risk of stroke for head and neck cancer patients receiving radiation therapy. These analyses allow the use of relatively large numbers to obtain “significant” P values. Their finding of a 46% to 70% higher cause-specific hazard of stroke with radiation therapy compared with the “control” of surgery alone seems very compelling.
Source: International Journal of Radiation Oncology * Biology * Physics - January 4, 2017 Category: Radiology Authors: Pierre Blanchard, Adam S. Garden Tags: Comment Source Type: research

Evaluating the Primary Prevention of Ischemic Stroke of Oral Antithrombotic Therapy in Head and Neck Cancer Patients with Radiation Therapy.
Abstract Although previous studies demonstrated the risk of ischemic stroke (IS) in patients with head and neck cancer (HNC), the impact of oral antithrombotic therapy (OAT) on this risk has not yet been assessed. We aimed to evaluate the effectiveness and safety of OAT in patients with HNC treated with RT. This retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. A total of 37,638 patients diagnosed with HNC included in the study were classified as users and nonusers of OAT. Primary outcome was IS or transient ischemic attack (TIA), and secondary outcomes were ...
Source: Biomed Res - December 20, 2016 Category: Research Authors: Hsu CW, Huang YB, Kuo CC, Chen CY Tags: Biomed Res Int Source Type: research

SMART syndrome: Classic transient symptoms leading to an unusual unfavorable outcome.
CONCLUSION: SMART syndrome may progress from a benign reversible form to a severe and eventually irreversible form. This severe course may also be confused with tumor progression, and lead to permanent disability and inadequate antitumor treatment. Clinicians should be aware of this latter atypical presentation. PMID: 27919464 [PubMed - as supplied by publisher]
Source: Revue Neurologique - December 8, 2016 Category: Neurology Tags: Rev Neurol (Paris) Source Type: research

Ntox-11. recurrent episodes of stroke-like migraine attacks after radiation therapy (smart) syndrome in adults
We report two cases of multiply-recurrent SMART syndrome, one autopsy-documented. Case 1 is a 46 year old woman with an atypical meningioma treated with resection and radiation who presented sixteen months after completion of radiation with sudden onset hemiparesis and dysarthria. Brain MRI showed the typical gyriform enhancement seen in SMART syndrome. No other attributable disorders were found on extensive workup, and both symptoms and radiographic abnormalities resolved over several weeks without further therapies. Six months later she again presented with identical symptoms and MRI findings. Incomplete resolution ...
Source: Neuro-Oncology - November 6, 2016 Category: Cancer & Oncology Authors: Mohler, A., Kleinschmidt-DeMasters, B. K., Damek, D. Tags: NEUROTOXICITY OF THERAPY Source Type: research

E-067 Endovascular Approach in the Repair of the Middle Cerebral Artery Aneurysm Including Those with Wide Neck and Complex in Morphology-A Case Series
ConclusionsEndovascular repair of the MCA aneurysm inclosing those with wide neck and complex are not only safe and feasible, but associated with high long-term functional outcome. Therefore, endovascular options must be offered to patients prior to surgical clipping of a MCA aneurysm. Further study may be warranted.DisclosuresY. Lodi: None. V. Reddy: None.
Source: Journal of NeuroInterventional Surgery - July 28, 2016 Category: Neurosurgery Authors: Lodi, Y., Reddy, V. Tags: Electronic poster abstracts Source Type: research