de Oliveira Franco Álvaro, Anzolin Eduardo, Schneider Medeiros Marcio, Machado Castilhos Raphael, Targa Martins Rodrigo, Moser Filho Humberto Luiz
Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Neurosurgery Department, Hospital Cristo Redentor, Porto Alegre, Brazil.
Case Rep Neurol. 2021 Jan 25;13(1):40-45. doi: 10.1159/000510518. eCollection 2021 Jan-Apr.
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare late complication of brain irradiation. Patients commonly present recurrent attacks of headaches, seizures, and paroxysmal focal neurological deficits including aphasia, negligence, or hemianopsia. We report a 41-year-old male patient admitted to our emergency room with a reduced level of consciousness and global aphasia. One month prior to admission, he started with frequent headache attacks of moderate intensity and paroxysmal behavioral alterations, advancing to confusion, gait instability, language impairment, and somnolence. He had a history of medulloblastoma treated with surgical resection followed by craniospinal irradiation 21 years before symptom onset. After excluding more frequent causes for the patient's symptoms along with a suggestive image pattern, we started treatment for SMART syndrome with high-dose corticosteroid and calcium channel blocker verapamil. The patient gradually improved his level of consciousness and recovered from aphasia and gait instability without new seizures or neuropsychiatric symptoms. Follow-up brain magnetic resonance imaging showed resolution of the typical findings. This case displays a successful clinical evolution of a patient treated for SMART syndrome in which identification of previous radiation treatment, exclusion of other etiologies, and prompt treatment institution were key for effectively tackling this disease.
放疗后类中风性偏头痛发作（SMART）综合征是脑部放疗罕见的晚期并发症。患者通常表现为头痛、癫痫发作以及阵发性局灶性神经功能缺损的反复发作，包括失语、疏忽或偏盲。我们报告一名41岁男性患者因意识水平下降和完全性失语入住我们的急诊室。入院前一个月，他开始出现频繁的中度强度头痛发作和阵发性行为改变，进而发展为意识模糊、步态不稳、语言障碍和嗜睡。他有髓母细胞瘤病史，在症状出现前21年接受了手术切除，随后进行了全脑全脊髓放疗。在排除患者症状更常见的病因并结合具有提示性的影像表现后，我们开始用高剂量皮质类固醇和钙通道阻滞剂维拉帕米治疗SMART综合征。患者意识水平逐渐改善，失语和步态不稳症状消失，未出现新的癫痫发作或神经精神症状。随访脑部磁共振成像显示典型表现消失。本病例展示了一名接受SMART综合征治疗患者的成功临床进展，其中识别既往放疗史、排除其他病因以及及时开始治疗是有效应对该疾病的关键。
