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Stroke-like migraine attacks after radiation therapy (SMART) syndrome—a case series and review

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Abstract

Introduction

Cranial irradiation is used both prophylactically and for the treatment of brain tumors. There are various complications associated with it. The rare complication of stroke-like migraine attacks after radiation therapy (SMART) syndrome usually occurs several years after radiation therapy but is a reversible phenomenon. It usually presents with headaches, seizures, or other focal neurological deficits concerning stroke or recurrence of the underlying disease.

Objectives

We aim to present two cases of SMART syndrome highlighting the typical presentation, imaging findings, and differential diagnosis. We also conducted the literature review since the early recognition of this rare delayed onset complication is crucial, given its self-limited course and to avoid misinterpretations of the cases.

Conclusion

Our extensive review favors MRI, CT, and prolonged EEG monitoring to rule out other differentials and showed that initiation of corticosteroid therapy and antiepileptic treatment were helpful in the resolution of symptoms and prevent recurrences. Therefore, future studies should be focused on early identification and management guidelines for SMART syndrome.

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Authors and Affiliations

  1. Department of Neurology, Creighton University School of Medicine, Omaha, NE, 68122, USA

    Urvish K. Patel & Abhishek Lunagariya

  2. Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Urvish K. Patel & Preeti Malik

  3. Department of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA

    Khush Patel

  4. Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia

    Ahmed Elkady

  5. Medical School, Drexel University College of Medicine, Philadelphia, PA, USA

    Nidhi Patel

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Contributions

Conception or design of the work: UP; data collection: PM, KP, AE; data analysis and interpretation: na; drafting the article: UP, PM, KP, AE, NP; critical revision of the article: AL, PM; final approval of the version to be published: UP, AE, AL.

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Correspondence to Urvish K. Patel.

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The patients’ identity is not disclosed anywhere, and the review article does not have direct or indirect involvement of human or animal, and IRB or ethics committee approval was not required to publish this work.

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Patel, U.K., Patel, K., Malik, P. et al. Stroke-like migraine attacks after radiation therapy (SMART) syndrome—a case series and review. Neurol Sci 41, 3123–3134 (2020). https://doi.org/10.1007/s10072-020-04586-0

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