28 March 2020 : Case report
SMART (Stroke-Like Migraine Attacks After Radiation Therapy) Syndrome: A Case Study with Imaging Supporting the Theory of Vascular Dysfunction
Mistake in diagnosis, Rare diseaseRakesh Danny Biju1ABCDEF*, Ashraf Dower1ADE, Benjamin G. Moon2ABCE, Peter Gan1AD
Am J Case Rep 2020; 21:e921795
BACKGROUND: SMART (Stroke-like Migraine Attacks after Radiation Therapy) syndrome is an uncommon delayed complication of cerebral radiotherapy. Less than 50 cases have been reported in the literature since it was first described in 1995. On average, presentation is about 20 years after radiotherapy, and patients commonly present with headaches, complex seizures, and stroke-like symptoms. The exact pathophysiology of the disease remains poorly understood, but one theory suggests radiation-induced vascular dysfunction.
CASE REPORT: We present one such case of a 28-year-old man who presented to our Emergency Department with a gradually progressive severe headache and right-sided weakness developing over a few hours. MRI played a central role in the diagnosis of SMART syndrome, with serial studies demonstrating and supporting the theory of vascular dysfunction. The condition is usually self-limiting, and most patients achieve complete recovery of symptoms, as did ours. Its optimal management remains unclear.
CONCLUSIONS: Better understanding of the imaging findings in SMART syndrome may help differentiate it from tumor recurrence, cerebral infections, or vasculitis. Because the diagnosis of this condition portends a significantly better prognosis and substantially alters patient expectation and management, it is important that clinicians are aware of the usual delayed presentation, symptomology, and imaging findings.
Keywords: Cerebrovascular Disorders, Magnetic Resonance Angiography, Radiotherapy, Diagnosis, Differential, Glucocorticoids, Methylprednisolone, Migraine Disorders, Radiation Injuries, Seizures, Syndrome
23 November 2022 : Case reportMepolizumab as a Potential Protective Factor of COVID-19 Mortality: A Case Report of Chronic Bronchitis and...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938450
01 November 2022 : Case reportCentral Retinal Vein Occlusion After Discontinuation of Rivaroxaban Therapy in a Young Patient with COVID-1...
Am J Case Rep 2022; 23:e937739
25 October 2022 : Case reportInhaled Nitric Oxide in Acute Severe Pulmonary Hypertension and Severe Acute Respiratory Distress Syndrome ...
Am J Case Rep 2022; 23:e937147
25 Nov 2022 : Case reportA Case Report of Listeria Meningitis with Severe Rhabdomyolysis and Normal Renal Function
Am J Case Rep In Press; DOI: 10.12659/AJCR.938024
24 Nov 2022 : Case reportCardiac Arrest Following Torsades de Pointes Caused by Hypokalemia and Catecholamines in a Patient with Con...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938609
24 Nov 2022 : Case reportA Large Pericardial Cyst in the Left Cardiophrenic Causing Persistent Chest Pain and Cough: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.937785
Most Viewed Current Articles
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406