SMART syndrome: a late reversible complication of radiotherapy

Abstract

A 43-year-ol d female had a cerebellar pilocytic astrocytoma operated 27 years ago. Reoperation and radiation therapy were employed in a recurrence 13 years ago. One week before admission, progressive drowsiness, disorientation in time and space, slurred speech and worsening of a residual right hemiparesis begun. Cerebrospinal uid (CSF) analysis and electroencephalography (EEG) were unremarkable. She improved without speci c therapy. Recently recognized stroke-like migraine attacks after radiation therapy (SMART) is a syndrome which consists of prolonged, unilateral neurological symptoms that are spontaneously reversible 1-4. Magnetic resonance (MR) ndings are fundamental for diagnosis, characterized by transient, dramatic, but reversible cortical gadolinium enhancement of the a ected cerebral hemisphere 1-3 (Figs 1 and 2). Appropriate diagnostic workup should exclude other diagnostic possibilities.