SMART syndrome

The incidence of late adverse effects of brain radiation therapy, such as stroke-like migraine attacks after radiation therapy (SMART) syndrome, is expected to rise due to improvements in cancer survival rates. SMART syndrome, though rare, has been reported in patients who previously underwent brain radiation therapy, even at lower doses. The pathophysiology remains unclear, with proposed causes including disruption of the trigeminovascular system and radiation-induced neuronal dysfunction.

Characterized by subacute neurological symptoms and migraine-like headaches, SMART syndrome typically manifests years after radiation therapy, with MRI showing unilateral cortical hyperintensities. Diagnosis relies on clinical and radiological findings, with proposed diagnostic criteria including a history of brain radiation therapy, reversible clinical manifestations, unilateral cortical gadolinium enhancement on MRI, eventual recovery, absence of tumor recurrence, and exclusion of other diseases.

While SMART syndrome often resolves completely, some patients may experience sequelae or relapses. Treatment focuses on symptom management, with corticosteroids being controversial due to their efficacy in improving neurological deficits. Overall, understanding and recognizing SMART syndrome is crucial for effective management and improved outcomes in patients with a history of brain radiation therapy for malignancy.