Stroke-Like Migraine Attacks after Radiation Therapy Syndrome: Clinical and Imaging Characteristics

Abstract

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare, reversible phenomenon that occurs several years after radiotherapy in patients treated for intracranial neoplastic lesions. Patients typically present with symptoms of headache, seizures, and other focal neurologic deficits concerning for stroke or disease recurrence. In this report, we describe SMART syndrome in a 70-year-old male who developed a persistent right temporal headache, right-sided neck pain, and new-onset seizures 12 years after surgical resection of a temporal anaplastic ependymoma followed by irradiation. We present this case to highlight typical disease presentation, imaging characteristics, and important differential radiologic considerations. Recognition of this delayed complication of brain tumor radiation is paramount given its self-limited course and favorable response to conservative therapy and to avoid misinterpreting imaging findings as tumor recurrence.

Surgical Management of Macrodystrophia Lipomatosa, a rare case report of the left hand middle finger macrodactyly

“…Macrodystrophia lipomatosa is a non-hereditary congenital disorder affecting a small part of the limb/finger or the entire limb which is seen as localized gigantism. Characterized by a complete enlargement of the fingers, usually the thumb and index finger, caused by an abnormal proliferation of fibroadipous tissue, fatty infiltration and hypertrophy of all components of the finger, including skin, bone, and nerves [8] .…”

“…There is bone enlargement and this deviation usually continues until the epiphyseal plate closes. The soft tissue will continue getting bigger with age [3] , [5] , [8] .…”

“…There are complaints related to neurovascular compression due to swelling and may be accompanied by pain or not, degenerative changes, and impaired/loss of function of fingers or limbs. The presence of this enlargement will also tend to make the joint relatively stiffer, thus limiting the movement function of the affected limb [3] , [8] . Some cases may be accompanied by the presence of syndactyly, clinodactyly, brachidactyly and polydactyly [5] , [6] .…”

“…Ultrasound examination shows tissue hypertrophy and the nerve involvement, hypertrophy distribution of adipose tissue (subcutaneous, intermuscular or intramuscular), and calcification, abnormal blood flow due to vascular malformations missed by plain radiographs [2] , [8] .…”

“…Attempts to maintain neurological function must be endeavored in the management of surgery. Amputation is performed when the affected limb cannot be maintained or the fingers cannot function properly after therapy, and to prevent further complications such as nerve entrapment in the future [2] , [6] , [8] . In this case we performed surgery by debulking to reduce the mass since there were a compression of the nerve indicated by tingling sensation at the fingertip, functional impairment due to enlargement of the finger by limited joint motion of the finger, and cosmesis problem.…”