Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA.
Division of Neuro-oncology, Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
Neuroradiology. 2021 Aug;63(8):1377-1381. doi: 10.1007/s00234-021-02684-0. Epub 2021 Mar 11.
The authors present an atypical case of presumed stroke-like migraine attacks after radiation therapy (SMART) syndrome in the brainstem. A 29-year-old male, who had been treated with resection and subsequent craniospinal radiation for posterior fossa medulloblastoma 21 years before, presented with subacute progressive left hemiparesis evolving over 4 days. Hematological findings, cerebrospinal fluid (CSF), and electroencephalogram (EEG) were unremarkable. Magnetic resonance imaging (MRI) showed a round area of hyperintense FLAIR signal centered within the pons associated with central restricted diffusion, peripheral enhancement, and small paramagnetic low susceptibility signal foci consistent with petechial hemorrhage. Positron emission tomography (PET), perfusion MRI, and MR spectroscopy revealed no evidence of tumor recurrence. The diagnosis of SMART syndrome is presumed from the conventional and advanced imaging findings, clinical history, and clinical course.
作者介绍了一例脑干卒中样偏头痛发作后拟诊放射治疗（SMART）综合征的不典型病例。一名 29 岁男性，21 年前因后颅窝髓母细胞瘤接受了切除术和随后的颅脊髓放疗，4 天前出现亚急性进行性左侧偏瘫。血液学检查、脑脊液（CSF）和脑电图（EEG）均无异常。磁共振成像（MRI）显示桥脑中心有一个圆形高信号 FLAIR 区域，伴有中央受限扩散、周围强化和小的顺磁性低信号灶，符合瘀点样出血。正电子发射断层扫描（PET）、灌注 MRI 和磁共振波谱未显示肿瘤复发的证据。根据常规和先进的影像学表现、临床病史和临床过程，诊断为 SMART 综合征。
