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Abstract Details

Stroke-like Migraine Attacks after Radiation Therapy (SMART) Syndrome: “Stroke-Like Migraine or Migrainous Stroke?”
Headache
Headache Posters (7:00 AM-5:00 PM)
083
To report two cases of SMART syndrome with persistent neurologic deficits, highlighting the possibility of irreversible brain damage.
Stroke-Like Migraine Attacks after Radiation Therapy Syndrome is a rare neurologic condition that occurs usually  >10 years after brain irradiation. Patients typically present with a combination of migrainous headaches, seizures and completely reversible focal neurologic deficits.
The first case is a 51-year-old female who presented with recurrent attacks of migrainous headache, word-finding difficulty, right-sided weakness and field cut for 4 years. She reported a history of brain radiation for a high-grade glioma 25 years earlier. She had 3 attacks with complete recovery within a few days. However, the 4th attack resulted in persistent right-sided hemiparesis.
The second case is a 49-year old male who had high-grade glioma resection and radiation therapy 15 years ago. He presented with recurrent migrainous headaches associated with right visual field cut. He had 3 spells within 4 months. He used to have occasional severe headaches for the last 2 years but without focal neurological deficit.  He continued to have right-visual field cut for weeks despite resolution of the headache.
MRI Brain in both cases revealed evidence of left hemispheric cortical diffusion restriction during the spells with associated T2 hyperintensity on FLAIR imaging and no post-contrast enhancement. There was evidence of post glioma resection encephalomalacia. No seizures were recorded on EEG; however, there was an evidence of left temporal sharp waves in our first case.
Although SMART syndrome typically presents with transient migrainous headaches, seizures and reversible focal neurologic deficits, our cases illustrate that SMART can lead to permanent brain damage and disability and as such consideration for acute and preventive treatment should be made. Pulse steroid therapy has been reported to hasten recovery. Our second patient responded well to propranolol but data on preventive treatment is scarce.
Authors/Disclosures
Ahmed Abbas, MD
PRESENTER 		Dr. Abbas has nothing to disclose.
Faisal A. Ibrahim, MD (Cleveland Clinic Foundation) Dr. Ibrahim has nothing to disclose.
No disclosure on file
Ammar Tarabichi, MD Dr. Tarabichi has nothing to disclose.