PT  - JOURNAL ARTICLE
AU  - Black, D.F.
AU  - Morris, J.M.
AU  - Lindell, E.P.
AU  - Krecke, K.N.
AU  - Worrell, G.A.
AU  - Bartleson, J.D.
AU  - Lachance, D.H.
TI  - Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome Is Not Always Completely Reversible: A Case Series
AID  - 10.3174/ajnr.A3602
DP  - 2013 Dec 01
TA  - American Journal of Neuroradiology
PG  - 2298--2303
VI  - 34
IP  - 12
4099  - http://www.ajnr.org/content/34/12/2298.short
4100  - http://www.ajnr.org/content/34/12/2298.full
SO  - Am. J. Neuroradiol.2013 Dec 01; 34
AB  - SUMMARY: We retrospectively reviewed clinical and imaging findings in 11 patients with stroke-like migraine attacks after radiation therapy (SMART) syndrome to better understand this disorder previously thought to be reversible. Six men and 5 women had complex bouts of neurologic impairment beginning, on average, 20 years after cerebral irradiation. All had characteristic, unilateral gyriform enhancement on MR imaging that developed within 2–7 days and typically resolved in 2–5 weeks. Unlike prior reports, 45% had incomplete neurologic recovery manifesting as dysphasia, cognitive impairment, or hemiparesis. The remaining 55% recovered completely over an average of 2 months. Three of 11 patients developed cortical laminar necrosis. Brain biopsies in 4 of 11 did not demonstrate a specific pathologic substrate. These additional 11 patients contribute to the understanding of variability in stroke-like migraine attacks after radiation therapy syndrome, which often but not uniformly manifests with headaches and seizures, demonstrates a typical evolution of imaging findings, and may result in permanent neurologic and imaging sequelae. SMARTstroke-like migraine attacks after radiation therapyCLNcortical laminar necrosisCJDCreutzfeldt-Jakob diseasePIPGperi-ictal pseudoprogression