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Alemany M, Velasco R, Simó M, Bruna J. Late effects of cancer treatment: consequences for long-term brain cancer survivors. Neurooncol Pract 2020; 8:18-30. [PMID: 33664966 DOI: 10.1093/nop/npaa039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Late adverse effects of cancer treatments represent a significant source of morbidity and also financial hardship among brain tumor patients. These effects can be produced by direct neurologic damage of the tumor and its removal, and/or by complementary treatments such as chemotherapy and radiotherapy, either alone or combined. Notably, young adults are the critical population that faces major consequences because the early onset of the disease may affect their development and socioeconomic status. The spectrum of these late adverse effects is large and involves multiple domains. In this review we classify the main long-term adverse effects into 4 sections: CNS complications, peripheral nervous system complications, secondary neoplasms, and Economic impact. In addition, CNS main complications are divided into nonfocal and focal symptoms. Owing to all the secondary effects mentioned, it is essential for physicians to have a high level of clinical suspicion to prevent and provide early intervention to minimize their impact.
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Affiliation(s)
- Montse Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
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Boyer PN, Devlin M, Boggild M. Rare and rarer: co-occurrence of stroke-like migraine attacks after radiation therapy and Charles Bonnet syndromes. Oxf Med Case Reports 2018; 2018:omy077. [PMID: 30323940 PMCID: PMC6172599 DOI: 10.1093/omcr/omy077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/18/2018] [Accepted: 07/28/2018] [Indexed: 11/18/2022] Open
Abstract
A 30-year-old man presented with new onset severe headache and homonymous hemianopia, with a subsequent seizure, on a background of a right parietal astrocytoma resected at age 5 with adjuvant chemotherapy and radiotherapy. Magnetic resonance imaging of the brain revealed post-surgical and radiotherapy changes only and a clinical diagnosis of Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome was made. Vision subsequently recovered gradually over a 6-week period, however, during the recovery phase he reported well formed hallucinations in the affected hemi-field consisting of small mammals, particularly possums, which gradually became less distinct as vision recovered; a phenomenon which was felt likely to represent the Charles Bonnet syndrome.
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Affiliation(s)
| | - Michael Devlin
- Neurology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Mike Boggild
- Neurology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
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Jia W, Saito R, Kanamori M, Iwabuchi N, Iwasaki M, Tominaga T. SMART (stroke-like migraine attacks after radiation therapy) syndrome responded to steroid pulse therapy: Report of a case and review of the literature. eNeurologicalSci 2018; 12:1-4. [PMID: 30003148 PMCID: PMC6040931 DOI: 10.1016/j.ensci.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 01/06/2023] Open
Abstract
This report presents a case of stroke-like migraine attacks after radiation therapy (SMART) syndrome in a 31-year-old man in whom symptoms and radiological findings resolved with steroid pulsed therapy and reviews the literatures with special emphasis on the use of steroids against SMART syndrome. The patient had a past history of left temporal anaplastic astrocytoma and was treated with surgery followed by local 72 Gy radiation therapy and chemotherapy using Nimustine Hydrochloride. Four years after the surgery, he was suffering from subacute progressing symptoms of headache, right hemianopia, right hemiparesis and aphasia from 2 to 4 days before admission to our hospital. At first he was diagnosed as symptomatic epilepsy but after extensive examination, the final diagnosis was SMART syndrome. His symptoms soon improved with steroid pulse therapy. In the literature, steroid pulse therapy is not necessarily a standard of care for SMART syndrome, but it seemed to decrease the need of biopsy. As the lesions of SMART syndrome require differential diagnosis from recurrences, biopsy was performed in some cases. However, lack of benefit and possible detriment is reported with biopsy of SMART lesions. Through this experience we suggest that steroid pulse therapy may provide speedy recovery from symptoms, and it should be considered before other invasive investigations or treatments. Report a case of stroke-like migraine attacks after radiation therapy (SMART) syndrome in a 31-year-old man in whom symptoms and radiological findings resolved with steroid pulsed therapy. Lack of benefit and possible detriment is reported with biopsy of SMART lesions. Steroid pulse therapy is not necessarily a standard of care for SMART syndrome, but it seemed to decrease the need of biopsy. Steroid pulse therapy may provide recovery from symptoms of SMART, and should be considered before invasive investigations.
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Affiliation(s)
- Wenting Jia
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Naoya Iwabuchi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Singh AK, Tantiwongkosi B, Moise AM, Altmeyer WB. Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature. Neuroradiol J 2017; 30:568-573. [PMID: 28643603 PMCID: PMC5703131 DOI: 10.1177/1971400917690009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old female presented with vision loss accompanied by migraine-like headaches. A contrast-enhanced magnetic resonance imaging of the brain was performed which revealed findings suggestive of stroke-like migraine attacks after radiation therapy (SMART) syndrome. SMART syndrome is a delayed complication of brain radiation characterized by neurologic symptoms including migraine-like headaches, seizures, and hemispheric impairment. The purpose of this article is to make the readers aware of this rare complication of brain irradiation. Appropriate diagnosis of SMART syndrome is essential to avoid invasive tests.
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Affiliation(s)
- Achint K Singh
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Bundhit Tantiwongkosi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | | | - Wilson B Altmeyer
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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Fan EP, Heiber G, Gerard EE, Schuele S. Stroke-like migraine attacks after radiation therapy: A misnomer? Epilepsia 2017; 59:259-268. [PMID: 29171011 DOI: 10.1111/epi.13963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To understand the frequency of electrographic and clinical seizures in patients with stroke-like migraine attacks after radiation therapy (SMART), and determine whether SMART warrants comprehensive electroencephalographic (EEG) monitoring and aggressive seizure management. METHODS We searched our magnetic resonance brain imaging report database for all patients between January 2013 and December 2015 for suspected SMART syndrome. Clinical inclusion criteria were further applied as follows: inpatient adults (>18 years of age) with history of cranial radiation presenting with acute neurologic deficits as primary admission reason who lacked evidence of recurrent or new brain malignancy, stroke, or infectious agents in cerebrospinal fluid. Six patients were identified. All 6 patients underwent prolonged video EEG monitoring as part of our standard protocol. RESULTS All patients but 1 were found to have multiple or prolonged electrographic seizures consistent with status epilepticus during video EEG monitoring. Their neurological deficit and/or mental status change improved in parallel with resolution of the seizure activity. SIGNIFICANCE SMART is likely a misnomer that underestimates the significance of seizures and status epilepticus in the pathophysiology and clinical presentation of the syndrome. Systematic continuous EEG monitoring and appropriate seizure management is warranted to reduce symptom duration and optimize clinical outcome.
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Affiliation(s)
- Emily Peien Fan
- Department of Neurology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Gabriel Heiber
- Department of Psychiatry, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Elizabeth E Gerard
- Department of Neurology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Stephan Schuele
- Department of Neurology, Northwestern Memorial Hospital, Chicago, IL, USA
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Bompaire F, Zinchenko L, Lahutte M, Mokhtari K, Psimaras D, Gaultier C, Monjour A, Delattre JY, Ricard D. SMART syndrome: Classic transient symptoms leading to an unusual unfavorable outcome. Rev Neurol (Paris) 2017; 173:67-73. [DOI: 10.1016/j.neurol.2016.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/30/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
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Rigamonti A, Lauria G, Mantero V, Filizzolo M, Salmaggi A. SMART (stroke-like migraine attack after radiation therapy) syndrome: a case report with review of the literature. Neurol Sci 2015; 37:157-161. [DOI: 10.1007/s10072-015-2396-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Gupta A, Etherton MR, McKee K, Baker JM, Izzy S, Feske SK. Clinical Reasoning: A 68-year-old man with a history of lung cancer presenting with right-sided weakness and aphasia. Neurology 2015; 85:e104-7. [PMID: 26438622 DOI: 10.1212/wnl.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anoopum Gupta
- From the Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I.), Massachusetts General Hospital and Harvard Medical School; and Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I., S.K.F.), Brigham and Women's Hospital, Boston, MA
| | - Mark R Etherton
- From the Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I.), Massachusetts General Hospital and Harvard Medical School; and Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I., S.K.F.), Brigham and Women's Hospital, Boston, MA.
| | - Kathleen McKee
- From the Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I.), Massachusetts General Hospital and Harvard Medical School; and Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I., S.K.F.), Brigham and Women's Hospital, Boston, MA
| | - Jessica M Baker
- From the Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I.), Massachusetts General Hospital and Harvard Medical School; and Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I., S.K.F.), Brigham and Women's Hospital, Boston, MA
| | - Saef Izzy
- From the Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I.), Massachusetts General Hospital and Harvard Medical School; and Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I., S.K.F.), Brigham and Women's Hospital, Boston, MA
| | - Steven K Feske
- From the Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I.), Massachusetts General Hospital and Harvard Medical School; and Department of Neurology (A.G., M.R.E., K.M., J.M.B., S.I., S.K.F.), Brigham and Women's Hospital, Boston, MA
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Zheng Q, Yang L, Tan LM, Qin LX, Wang CY, Zhang HN. Stroke-like Migraine Attacks after Radiation Therapy Syndrome. Chin Med J (Engl) 2015; 128:2097-101. [PMID: 26228225 PMCID: PMC4717966 DOI: 10.4103/0366-6999.161393] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of stroke-like migraine attacks after radiation therapy (SMART) syndrome, and to propose diagnostic criteria for this disorder. DATA SOURCES We searched the PubMed database for articles in English published from 1995 to 2015 using the terms of "stroke-like AND migraine AND radiation." Reference lists of the identified articles and reviews were used to retrieve additional articles. STUDY SELECTION Data and articles related to late-onset effects of cerebral radiation were selected and reviewed. RESULTS SMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies. The recovery, which ranges from hours to days to weeks, can be partial or complete. We propose the following diagnostic criteria for SMART: (1) Remote history of therapeutic external beam cranial irradiation for malignancy; (2) prolonged, reversible clinical manifestations mostly years after irradiation, which may include migraine, seizures, hemiparesis, hemisensory deficits, visuospatial defect, aphasia, confusion and so on; (3) reversible, transient, unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region; (4) eventual complete or partial recovery, the length of duration of recovery ranging from hours to days to weeks; (5) no evidence of residual or recurrent tumor; (6) not attributable to another disease. To date, no specific treatment has been identified for this syndrome. CONCLUSIONS SMART is an extremely rare delayed complication of brain irradiation. However, improvements in cancer survival rates have resulted in a rise in its frequency. Hence, awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.
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Affiliation(s)
- Qian Zheng
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Li-Ming Tan
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Li-Xia Qin
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Chun-Yu Wang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Hai-Nan Zhang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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Jaraba S, Puig O, Miró J, Velasco R, Castañer S, Rodríguez L, Izquierdo C, Simó M, Veciana M, Falip M. Refractory status epilepticus due to SMART syndrome. Epilepsy Behav 2015; 49:189-92. [PMID: 26071996 DOI: 10.1016/j.yebeh.2015.05.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stroke-like migraine attacks after radiation therapy (SMART) is a late-onset complication of brain irradiation of unknown physiopathology. Our aim was to present three patients with SMART syndrome who had clinical and neuroimage studies suggestive of status epilepticus. PATIENTS Patient 1. A 69-year-old woman, who was treated with radiation therapy 14 years before her first admission to the Neurology Department, presented with several episodes of headache, speech disturbances, and weakness of left limbs with altered awareness. Patient 2. A 49-year-old man, who was treated with whole brain radiation 20 years before the onset of symptoms, developed some episodes consisting of headache and numbness of the right side of face and right arm; the latest episodes were accompanied by visual disturbances followed by generalized tonic-clonic seizures. Patient 3. A 40-year-old man, who received cranial irradiation 20 years before, suffered three episodes of behavioral disturbance, aphasia, headache, and visual aura followed by left homonymous hemianopia. RESULTS All three patients suffered seizures mostly with visual aura. Electroencephalography showed interictal epileptiform discharges or focal slowing. Brain magnetic resonance image (MRI), positron emission tomography (PET), or ictal-single-photon emission computed tomography (SPECT) showed focal cortical hyperperfusion. Focal diffusion restriction and focal gadolinium-enhancement were observed on MRI. All patients were treated with antiepileptic drugs, being effective in one of them. One patient needed anesthesic coma, and the other patient responded to therapy with corticosteroids. 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".
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Affiliation(s)
- Sonia Jaraba
- Neurology Department, Epilepsy Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Neurology Department, Hospital de Viladecans, Viladecans, Barcelona, Spain.
| | - Oriol Puig
- Nuclear Medicine Department, SPECT Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Júlia Miró
- Neurology Department, Epilepsy Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Roser Velasco
- Neurology Department, Neuro-Oncology Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sara Castañer
- Image Diagnostic Institute, Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Rodríguez
- Image Diagnostic Institute, Nuclear Medicine Department, PET Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Izquierdo
- Neurology Department, Neuro-Oncology Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Simó
- Neurology Department, Neuro-Oncology Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Misericordia Veciana
- Neurophysiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mercè Falip
- Neurology Department, Epilepsy Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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The Syndrome of Stroke-like Migraine Attacks After Radiation Therapy Associated With Prolonged Unresponsiveness in an Adult Patient. Neurologist 2015; 19:49-52. [DOI: 10.1097/nrl.0000000000000003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Surgically Induced SMART Syndrome: Case Report and Review of the Literature. World Neurosurg 2014; 82:240.e7-12. [DOI: 10.1016/j.wneu.2013.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 08/27/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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Armstrong AE, Gillan E, DiMario FJ. SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients. J Child Neurol 2014; 29:336-41. [PMID: 23364656 DOI: 10.1177/0883073812474843] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
SMART syndrome (stroke-like migraine attacks after radiation therapy) is a rare condition that involves complex migraines with focal neurologic findings in patients following cranial irradiation for central nervous system malignancies. Little is known about the mechanisms behind the disorder, making successful treatment challenging. We report 2 new cases of SMART syndrome in pediatric patients as well as review all documented cases of the syndrome. Each of our 2 pediatric patients suffered multiple episodes. Attacks were characterized by severe headache, visual disturbance, aphasia, and weakness. Recovery occurred over several days to weeks. The data from all documented reports of SMART syndrome indicate a greater prevalence for male gender. An age-dependent pattern of onset was also observed, with a greater variability of syndrome onset in patients who received cranial irradiation at a younger age. SMART appears to be a reversible, recurrent long-term complication of radiation therapy with possible age- and gender-related influences.
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Affiliation(s)
- Amy E Armstrong
- 1University of Connecticut School of Medicine, Farmington, CT, USA
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Black DF, Morris JM, Lindell EP, Krecke KN, Worrell GA, Bartleson JD, Lachance DH. Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series. AJNR Am J Neuroradiol 2013; 34:2298-303. [PMID: 23788601 DOI: 10.3174/ajnr.a3602] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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.
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Truntzer P, Monjour A, Gaultier C, Ahle G, Guillerme F, Boutenbat G, Stilhart B, Salze P, Atlani D. SMART Syndrome : à propos d’un cas d’une complication rare après radiothérapie cérébrale et revue de la littérature. Cancer Radiother 2012; 16:295-301. [DOI: 10.1016/j.canrad.2012.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
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Normal Cerebrovascular Reactivity in Stroke-Like Migraine Attacks After Radiation Therapy Syndrome. Clin Nucl Med 2010; 35:583-5. [DOI: 10.1097/rlu.0b013e3181e4db6f] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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