Urvish K Patel1,2, Khush Patel3, Preeti Malik4, Ahmed Elkady5, Nidhi Patel6, Abhishek Lunagariya7. 1. Department of Neurology, Creighton University School of Medicine, Omaha, NE, 68122, USA. dr.urvish.patel@gmail.com. 2. Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. dr.urvish.patel@gmail.com. 3. Department of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA. 4. Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia. 6. Medical School, Drexel University College of Medicine, Philadelphia, PA, USA. 7. Department of Neurology, Creighton University School of Medicine, Omaha, NE, 68122, USA.
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.
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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