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March 7, 2016: Stroke-like migraine attacks after radiation therapy

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March 7, 2016

Stroke-like migraine attacks after radiation therapy (SMART) syndrome

Stroke-like migraine attacks after radiation therapy syndrome, primarily occurs 15-20 years after radiation therapy and can include complex migraine symptoms; seizures are also a common presenting complaint.1,2Imaging changes are characteristic, with diffuse, cortical hyperintensity and enhancement of the gyri, sparing the white matter and without respecting vascular territories.2 These findings are usually unilateral, occur within 2-7 days of symptom onset and resolve within several weeks.1 Most reported EEG findings demonstrate slowing in the affected area2, although there are some reported cases with epileptogenic or epileptogenic discharges interictally.1

  1. Black DF, Morris JM, Lindell EP, et al. Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series. Am J Neuroradiol 2013; 34: 2298-2303.
  2. Rigamonti A, Lauria G, Mantero V, et al. SMART (stroke-like migraine attack after radiation therapy) syndrome: A case report with review of the literature. Neurol Sci Epub 2015 Oct 14.

Submitted by Ilena George, MD, Department of Neurology, Yale School of Medicine, New Haven.

Disclosures: Dr. George is a member of the Resident and Fellow Section of Neurology.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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