SMART - Not Always Only "Stroke-Like"

Stroke-like migraine attacks after radiation therapy (SMART) is a syndrome observed in a delayed fashion in patients following brain radiation therapy. It is a rare but important differential diagnosis of migraine in these patients, often presenting with migraine-like headache. In addition, there may be focal neurological deficits or seizures. In general, it is regarded as a reversible condition, therefore termed stroke-like. Our case illustrates that there may also be ischemic stroke associated with SMART leading to an unfavorable course, even after prior remission.