The Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome in children
The SMART syndrome is a rare complication involving complex migraines (migraine like headaches) with cranial irradiation for central nervous system malignancies leading to focal neurologic findings in patients. Endothelial damage or dysfunction, vascular instability, vasospasm and neuronal dysfunction are some of its probable underlying mechanisms.
Here, a case of 11 years old girl who was presented with primary diagnosis of medulloblastoma 20 months after completing cranial radiotherapy. Then she had acute-onset severe headache and left-sided weakness. Unilateral cortical swelling and concomitant leptomeningeal, gyral contrast enhancement and MR perfusion imaging showed increased cortical perfusion in the right temporo-parieto-occipital region which was demonstrated in her MRI scan. In the coming days, her symptoms resolved spontaneously. Cranial radiotherapy lead to the long term, reversible complication - SMART syndrome. Till now, only a handful of pediatric patients with SMART syndrome have been outlined. Precise identification of clinical signs and radiological imaging of SMART syndrome may aid in suppressing unnecessary interventions and appropriate diagnostic management.