The Syndrome of Stroke-like Migraine Attacks After Radiation Therapy Associated With Prolonged Unresponsiveness in an Adult Patient

Abstract

Reduced level of consciousness of such severity and duration as observed here has not previously been described in SMART syndrome. This report, however, suggests that an excellent prognosis can be expected even in cases of prolonged unresponsiveness. The pathogenic mechanisms of SMART syndrome remain unclear, but may involve pathways common to both migraine and epilepsy.

Stroke‐like migraine attacks after radiation therapy: A misnomer?

“…22 Given common excitatory pathways of migraine and seizure, radiation effects on the trigeminovascular system causing neuronal dysfunction and a reduced threshold to cortical spreading depression may equally reduce the threshold for epileptogenic activity in SMART. [23][24][25] Functional imaging studies provide additional insight into the pathophysiology of SMART. Hametner and Jaraba demonstrated focal hypermetabolism and hypoperfusion on positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging, respectively.…”

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

“…Tomek et al. 22 reported a case of a patient with SMART syndrome with prolonged unresponsiveness with very slow recovery. Another case report by Singh et al.…”

Stroke-Like Migraine Attacks After Radiation Therapy (SMART): Um Caso Clínico

“…A realização de biópsia cerebral é rara e, na maioria dos casos descritos, sem achados anatomopatológicos específicos. 3,11 A patofisiologia da síndrome SMART ainda não está esclarecida. É considerada a possibilidade de se tratar de uma vasculopatia reversível secundária à radiação, por disfunção endotelial semelhante à encefalopatia posterior reversível (PRES).…”

“…6,12 Em alguns casos, os achados histológicos mostraram uma proliferação vascular, associada a infiltrados celulares perivasculares e gliose. 2,11 Alguns autores defendem que estas alterações na barreira hemato-encefálica resultariam em edema cortical, 8 enquanto outros parecem contrariar esta hipótese. 13 Outra hipótese considerada é a de disfunção neuronal, secundária ao impacto da radiação sobre o sistema trigeminovascular.…”