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Murine Salivary Functional Assessment via Pilocarpine Stimulation Following Fractionated Radiation
Published on: May 4, 2018
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Stroke-like Migraine Attacks after Radiation Therapy Syndrome
Qian Zheng, Li Yang, Li-Ming Tan
1Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Chinese Medical Journal
|August 1, 2015
Summary
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of brain irradiation. Increased cancer survival leads to more frequent cases, necessitating prompt diagnosis to avoid unnecessary invasive procedures.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication following cranial irradiation for central nervous system malignancies.
- Improvements in cancer survival rates have led to an increased incidence of this rare syndrome.
Purpose of the Study:
- To summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of SMART syndrome.
- To propose diagnostic criteria for SMART syndrome.
Main Methods:
- A comprehensive literature search was conducted using PubMed with terms 'stroke-like AND migraine AND radiation' from 1995 to 2015.
- Additional articles were retrieved from reference lists of identified publications and reviews.
- Data and articles related to late-onset effects of cerebral radiation were selected and reviewed.
Main Results:
- SMART syndrome presents as complex migraines with focal neurologic deficits post-cranial irradiation.
- Clinical manifestations are prolonged, reversible, and occur years after irradiation, including migraine, seizures, and focal deficits.
- Neuroimaging reveals reversible, transient, unilateral cortical gadolinium enhancement with corresponding signal abnormalities on T2 and FLAIR sequences.
- Recovery can be partial or complete, ranging from hours to weeks. No specific treatment has been identified.
Conclusions:
- SMART syndrome is an extremely rare delayed complication of brain irradiation.
- Increased awareness and recognition are crucial for rapid diagnosis and to prevent aggressive interventions like brain biopsy or cerebral angiography.
- Proposed diagnostic criteria include a history of cranial irradiation, prolonged reversible neurological deficits, characteristic neuroimaging findings, and absence of tumor or other causes.
