Wai Karmen, Balabanski Anna, Chia Nicholas, Kleinig Timothy
Department of Neurology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia.
Department of Neurology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia.
J Clin Neurosci. 2017 Sep;43:146-148. doi: 10.1016/j.jocn.2017.05.013. Epub 2017 Jun 20.
Stroke-like migraine attacks after radiation therapy (SMART) syndrome manifests as prolonged episodes of cortical dysfunction, years after cranial irradiation. We present two cases demonstrating reversible hemispheric hypoperfusion. Case 1 presented with left hemispheric symptoms following previous similar episodes. CT perfusion (CTP) demonstrated reversible hemispheric hypoperfusion; subsequent investigations were consistent with SMART syndrome. Case 2 presented following the third episode of a hemispheric syndrome with near-identical CTP abnormalities. L-arginine was administered with rapid reversal of clinical and CTP abnormalities. We conclude that SMART syndrome may demonstrate significant hypoperfusion on hyperacute CTP without subsequent infarction. Impaired cerebrovascular autoregulation probably contributes to cortical dysfunction in SMART syndrome. L-arginine warrants investigation as a potential treatment.
放疗后类卒中偏头痛发作（SMART）综合征表现为颅脑照射数年之后出现的长时间皮质功能障碍发作。我们报告两例显示可逆性半球灌注不足的病例。病例1在之前出现过类似发作后出现左侧半球症状。CT灌注成像（CTP）显示可逆性半球灌注不足；后续检查符合SMART综合征。病例2在出现第三次半球综合征发作后就诊，CTP异常情况几乎相同。给予L-精氨酸后临床和CTP异常迅速逆转。我们得出结论，SMART综合征在超急性期CTP上可能显示明显的灌注不足但随后并无梗死。脑血管自动调节功能受损可能是SMART综合征皮质功能障碍的原因。L-精氨酸作为一种潜在治疗方法值得研究。
