Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: A case series

David F. Black, J. M. Morris, E. P. Lindell, K. N. Krecke, G. A. Worrell, J. D. Bartleson, D. H. Lachance

Research output: Contribution to journalArticlepeer-review

46 Scopus citations

Abstract

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 remaining 55% recovered completely over an average of 2 months. Three of 11 patients developed cortical laminar necrosis. Brain biopsies in 4 of 11 did not demonstrate a specific pathologic substrate. These additional 11 patients contribute to the understanding of variability in stroke-like migraine attacks after radiation therapy syndrome, which often but not uniformly manifests with headaches and seizures, demonstrates a typical evolution of imaging findings, and may result in permanent neurologic and imaging sequelae.

Original languageEnglish (US)
Pages (from-to)2298-2303
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume34
Issue number12
DOIs
StatePublished - Dec 2013

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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