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SMART Syndrome Identification and Successful Treatment
Álvaro de Oliveira Franco1, Eduardo Anzolin2, Marcio Schneider Medeiros3
1Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Case Reports in Neurology
|February 22, 2021
Summary
Stroke-like migraine attacks after radiation therapy (SMART) syndrome, a rare complication, can cause neurological deficits. Prompt diagnosis and treatment with corticosteroids and verapamil led to successful recovery in a patient with a history of brain irradiation.
Area of Science:
- Neurology
- Radiation Oncology
Background:
- Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare but serious late complication following brain irradiation.
- It typically manifests as recurrent episodes of headaches, seizures, and transient focal neurological deficits.
Observation:
- A 41-year-old male presented with decreased consciousness and global aphasia, preceded by headaches and progressive neurological symptoms.
- His medical history included medulloblastoma treated with surgery and craniospinal irradiation 21 years prior.
Findings:
- After ruling out other causes and based on imaging, the patient was diagnosed with SMART syndrome.
- Treatment with high-dose corticosteroids and verapamil resulted in significant clinical improvement, including recovery of consciousness and resolution of aphasia and gait instability.
Implications:
- This case highlights the importance of considering SMART syndrome in patients with a history of cranial radiation presenting with neurological symptoms.
- Early identification of prior radiation exposure, exclusion of alternative diagnoses, and timely intervention are crucial for successful management and positive patient outcomes.
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