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CC BY 4.0 · Journal of Child Science 2021; 11(01): e327-e330
DOI: 10.1055/s-0041-1740466
Case Report

A Case of Postoperative SMART Syndrome in a Medulloblastoma Survivor

Cristian Cirjan
1   Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
,
Ali Jamal
2   Department of Neurology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, Missouri, United States
,
Philippe Mercier
3   Department of Neurosurgery, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, Missouri, United States
,
Rachel Berkovich
4   Department of Radiology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, Missouri, United States
,
Pournima Navalkele 
5   Division of Hematology Oncology, Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, Missouri, United States
› Author Affiliations Funding None.
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Abstract

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare neurological phenomenon characterized by reversible symptoms of headache, seizure, hemiparesis, and visual changes associated with a remote history of cranial irradiation. We describe a case of a medulloblastoma survivor, presenting with postoperative neurological deficits, along with neuroimaging findings and subsequent resolution of symptoms, highly suggestive of SMART syndrome. We have also reviewed the common epidemiological and diagnostic factors associated with this rare disease, as well as discussed pathophysiological mechanisms.

Keywords

radiation - migraine - stroke - SMART syndrome

Note

Written informed consent for publication of the clinical details was obtained from the legal guardian. A copy of the consent form is available for review by the editor of this journal.




Publication History

Received: 27 August 2021

Accepted: 02 November 2021

Article published online:
13 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Makary MS, Awan U, Puduvalli VK, Slone HW. Stroke-like migraine attacks after radiation therapy syndrome: clinical and imaging characteristics. J Clin Imaging Sci 2019; 9: 5
    CrossrefPubMedGoogle Scholar
  • 2 Khanipour Roshan S, Salmela MB, McKinney AM. Susceptibility-weighted imaging in stroke-like migraine attacks after radiation therapy syndrome. Neuroradiology 2015; 57 (11) 1103-1109
    CrossrefPubMedGoogle Scholar
  • 3 Dominguez M, Malani R. Stroke-like migraine attacks after radiation therapy (SMART) syndrome: a comprehensive review. Curr Pain Headache Rep 2021; 25 (05) 33
    CrossrefPubMedGoogle Scholar
  • 4 Shuper A, Packer RJ, Vezina LG, Nicholson HS, Lafond D. ‘Complicated migraine-like episodes’ in children following cranial irradiation and chemotherapy. Neurology 1995; 45 (10) 1837-1840
    CrossrefPubMedGoogle Scholar
  • 5 Black DF, Bartleson JD, Bell ML, Lachance DH. SMART: stroke-like migraine attacks after radiation therapy. Cephalalgia 2006; 26 (09) 1137-1142
    CrossrefPubMedGoogle Scholar
  • 6 Black DF, Morris JM, Lindell EP. et al. Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series. AJNR Am J Neuroradiol 2013; 34 (12) 2298-2303
    CrossrefPubMedGoogle Scholar
  • 7 Singh TD, Hajeb M, Rabinstein AA. et al. SMART syndrome: retrospective review of a rare delayed complication of radiation. Eur J Neurol 2021; 28 (04) 1316-1323
    CrossrefPubMedGoogle Scholar
  • 8 Maloney PR, Rabinstein AA, Daniels DJ, Link MJ. Surgically induced SMART syndrome: case report and review of the literature. World Neurosurg 2014; 82 (1-2): 240.e7-240.e12
    CrossrefPubMedGoogle Scholar
  • 9 Murphy ES, Xie H, Merchant TE, Yu JS, Chao ST, Suh JH. Review of cranial radiotherapy-induced vasculopathy. J Neurooncol 2015; 122 (03) 421-429
    CrossrefPubMedGoogle Scholar
  • 10 Armstrong AE, Gillan E, DiMario Jr FJ. SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients. J Child Neurol 2014; 29 (03) 336-341
    CrossrefPubMedGoogle Scholar