SMART Syndrome: A Reversible Complication After Radiation Therapy and Surgery for Brain Tumors

Sheehan, Jason P.

doi:10.1016/j.wneu.2013.01.101

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…There is no specific treatment for SMART syndrome and treatment is usually targeted towards controlling the symptoms, such as anticonvulsive therapy. 20,24…”

Section: Discussionmentioning

confidence: 99%

Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature

et al. 2017

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A 26-year-old female presented with vision loss accompanied by migraine-like headaches. A contrast-enhanced magnetic resonance imaging of the brain was performed which revealed findings suggestive of stroke-like migraine attacks after radiation therapy (SMART) syndrome. SMART syndrome is a delayed complication of brain radiation characterized by neurologic symptoms including migraine-like headaches, seizures, and hemispheric impairment. The purpose of this article is to make the readers aware of this rare complication of brain irradiation. Appropriate diagnosis of SMART syndrome is essential to avoid invasive tests.

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“…There is no specific treatment for SMART syndrome and treatment is usually targeted towards controlling the symptoms, such as anticonvulsive therapy. 20,24…”

Section: Discussionmentioning

confidence: 99%

Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature

et al. 2017

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“…MRI brain enhancement was found in the right hemisphere, but no other cause was found for the patient's headache aside from possible SMART syndrome . Because SMART syndrome is considered a consequence of therapy, it may be useful going forward to use current technologies such as MRI to evaluate the unintended effects of treating brain tumor patients …”

Section: Brain Tumor Headache In General and The Ichdmentioning

confidence: 99%

Headaches in Brain Tumor Patients: Primary or Secondary?

Nelson

Taylor

2014

Headache

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Our literature review revealed that brain tumor headache uncommonly presents with classic brain tumor headache characteristics and often satisfies criteria for a primary headache category such as migraine or tension-type. Thus, clinicians may miss headaches due to brain tumors in following ICHD-3 criteria, and the distinction between primary and secondary headache disorders may not be so clear-cut.

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“…the delayed occurrence makes it impossible to conduct adequate prospective studies. As a result, the current evidence is limited to isolated case reports and small case series [4][5][6][7][8][9][10][11][12]. Furthermore, accurate recognition of the unique clinical phenotype is complicated by the common occurrence of strokes and seizures in patients with a history of radiotherapy for central nervous system neoplasm, most of whom do not meet the evolving diagnostic criteria for SMART syndrome.…”

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confidence: 99%

SMART syndrome: retrospective review of a rare delayed complication of radiation

Singh

Hajeb

Rabinstein

et al. 2020

Euro J of Neurology

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Background SMART (stroke‐like migraine attacks after radiation therapy) is a rare, delayed complication of brain radiation. In this study, we wanted to review the spectrum of symptoms, neuroradiological findings, autoimmune status, and outcomes in SMART syndrome patients. Methods We conducted a retrospective cohort study of all consecutive adult patients (≥18 years) diagnosed with SMART syndrome at Mayo Clinic, Rochester between January 1995 and December 2018. Results We identified 25 unique patients with SMART syndrome and a total of 31 episodes and 15 (60%) patients were male. The median age at onset was 46 (interquartile range [IQR] 43–55) years and the median latency of onset after the initial radiation was 21.6 (IQR 14.4–28.2) years. Magnetic resonance imaging (MRI) showed gyral edema and enhancement in all cases with the temporal (25, 80.6%) and parietal (23, 74.2%) lobes being the most commonly affected. The median follow‐up of the patients in our cohort was 10 (IQR 6–32) weeks. On univariate analysis, factors associated with an increased risk of recurrent SMART episodes were female gender (odds ratio [OR] 8.1, 95% confidence interval [95% CI] 1.1–52.6, p = 0.019) and absence of electrographic seizure discharges during initial symptoms (OR 7.4, 95% CI 1.1–45.9, p = 0.032). We could not identify an autoimmune etiology. Longer duration of symptoms (>10 weeks) correlated with an older age (p = 0.049), temporal lobe involvement (p < 0.001), and diffusion restriction (p = 0.043). Conclusions SMART is a syndrome with characteristic imaging findings and clinical features. Incomplete recovery by 10 weeks occurred in one‐third of individuals and was associated with older age, temporal lobe involvement, and restricted diffusion on MRI.

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SMART Syndrome: A Reversible Complication After Radiation Therapy and Surgery for Brain Tumors

Cited by 4 publications

References 12 publications

Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature

Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature

Headaches in Brain Tumor Patients: Primary or Secondary?

SMART syndrome: retrospective review of a rare delayed complication of radiation

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