Department of Neurosurgery, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA.
Department of Neurology, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):240.e7-12. doi: 10.1016/j.wneu.2013.01.028. Epub 2013 Jan 10.
Strokelike migraine attack after radiation therapy is a recently described clinical entity characterized by transient hemispheric dysfunction manifesting as, but not limited to, visuospatial deficits, confusion, hemisensory deficits, hemiparesis, aphasia, seizures, and, most prominently, headache in patients with a history of remote external beam radiation therapy to the brain. The radiographic hallmark on magnetic resonance imaging is the presence of transient, diffuse, unilateral gadolinium enhancement of the cortex with white matter sparing, usually corresponding to the previous radiation field.
We present a case of strokelike migraine attacks after radiation therapy syndrome diagnosed immediately following a craniotomy and temporal lobectomy for recurrent metastatic tumor resection after prior gamma knife radiosurgery and whole-brain radiation therapy.
SMART syndrome should be considered in the differential diagnosis of postsurgical patients with remote history of cranial irradiation and significant, new transient neurologic deficits not explainable by any other mechanism. It is possible that manipulation of the trigeminal ganglion, or the dura of the Meckel cave, contributed to triggering the manifestations of this syndrome in our patient during the immediate postoperative period.
放射性治疗后出现类似中风的偏头痛发作是一种最近描述的临床实体，其特征为短暂的半球功能障碍，表现为但不限于视觉空间缺陷、意识混乱、半感觉缺失、偏瘫、失语、癫痫发作，以及最突出的是有脑部远处外照射放射治疗史的患者的头痛。磁共振成像的放射学标志是皮质的短暂、弥漫、单侧钆增强，伴白质保留，通常与先前的放射野相对应。
我们报告了一例放射性治疗后类似中风的偏头痛发作综合征病例，该患者在伽玛刀放射外科和全脑放射治疗后复发转移瘤切除行开颅手术和颞叶切除术，立即被诊断为该综合征。
对于有脑部远处照射史和明显新的非其他机制可解释的短暂神经功能缺损的术后患者，应考虑 SMART 综合征的鉴别诊断。在我们的患者中，在术后即刻，三叉神经节或 Meckel 腔硬脑膜的操作可能导致了这种综合征表现的触发。
