Abstract
Background/Objectives Patient receiving cranial radiotherapy can experience reversible hemispheric dysfunction because of delayed toxicity to the brain. Many patients do not fulfil the criteria for a diagnosis of stroke-like migraine attacks after radiotherapy (SMART) syndrome due to the requirement for distinctive imaging findings, and it is likely there is a broader spectrum of disease than previously believed. The aim of this study was to collect cases of stroke-like attacks which did not fulfil the diagnostic criteria to further characterise the typical clinical features, investigations findings and potential management of this condition.
Methods Cases were collected retrospectively from two South Australian hospitals of patients presenting with a history of cranial radiotherapy and an acute onset of neurological symptoms without fulfilling the diagnostic criteria for SMART syndrome.
Results Four patients with transient hemispheric dysfunction post-radiotherapy, who did not fulfil the diagnostic criteria for SMART syndrome, were identified. All patients presented with acute-onset focal neurological deficits, including expressive dysphasia (75%), hemiparesis (50%) and hemineglect (25%). No patients presented with MRI findings suggestive of SMART syndrome. Patients received either supportive management or pharmacotherapy with anti-seizure drugs, l-arginine, or a combination of medications, and were all discharged without residual neurological deficits relating to their episode.
Conclusion SMART syndrome likely exists on a spectrum, which includes patients exhibiting characteristic clinical features without imaging findings. More cases of stroke-like episodes post-radiotherapy need to be identified to further characterise this condition and establish a more inclusive set of diagnostic criteria.
