# Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Case Report

## TL;DR

A rare syndrome called SMART can cause migraine-like symptoms and brain issues years after radiation therapy, and it can be effectively treated with steroids and seizure medications.

## Contribution

This case report adds to the understanding of SMART syndrome and highlights its clinical features and treatment response.

## Key findings

- SMART syndrome can manifest years after cranial irradiation with symptoms like headache, visual aura, and neurological deficits.
- MRI and PET scans showed characteristic brain changes in the patient, supporting the SMART syndrome diagnosis.
- Treatment with pulse steroids and antiseizure medications led to complete recovery.

## Abstract

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare and delayed complication of brain irradiation involving impaired cerebrovascular autoregulation, and diagnosis is based on distinct clinic-radiographic findings and exclusion of differentials. We report a 38-year-old man, who received cranial irradiation 28 years before and developed episodes of headache and visual aura, followed by left hemianopia, aphasia, behavioral disturbances, and focal seizures. An MRI of the brain revealed gyral swelling with restricted diffusion and mild contrast enhancement over the right temporoparietal and occipital region, and fludeoxyglucose-FDG PET scan showed hyperperfusion in the corresponding brain region. He improved completely with pulse steroids and antiseizure medications. The recognition of this syndrome is important as we can reassure patients and their families and help avoid unnecessary and invasive diagnostic tests.