Flain Luke, Lay Aisha, Gadil Eden, James Karlie, Thanancheyan Sanchayan, Bacchi Stephen, Goh Rudy
Royal Darwin Hospital, Tiwi, NT, Australia.
Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
Case Rep Neurol. 2024 Jul 24;16(1):208-212. doi: 10.1159/000540417. eCollection 2024 Jan-Dec.
SMART syndrome is a rare complication of brain radiotherapy. This is the first described presentation of SMART syndrome with metamorphopsia, which responded to aspirin, verapamil, and high-dose L-arginine therapy.
A 43-year-old man presented with 3 weeks of migraine headaches with metamorphopsia and complex visual hallucinations affecting the left lower quadrant of both visual fields. This occurred on a background of high-dose radiotherapy for right cerebellar astrocytoma 32 years ago. MRI brain demonstrated unilateral gyriform enhancement and FLAIR hyperintense cortical swelling in the right occipital lobe consistent with SMART syndrome.
Unusual presentations of SMART syndrome exist and require consideration in all patients with focal neurological deficit post-brain radiotherapy. Validated diagnostic and treatment modalities for SMART syndrome are urgently required.
SMART综合征是脑放疗的一种罕见并发症。这是首次报道的伴有视物变形症的SMART综合征病例，该病例对阿司匹林、维拉帕米和高剂量L-精氨酸治疗有反应。
一名43岁男性，出现为期3周的偏头痛，伴有视物变形症以及影响双侧视野左下方象限的复杂视幻觉。这发生在32年前因右小脑星形细胞瘤接受高剂量放疗的背景下。脑部磁共振成像（MRI）显示右侧枕叶有单侧脑回样强化以及液体衰减反转恢复序列（FLAIR）高信号的皮质肿胀，符合SMART综合征。
SMART综合征存在不寻常的表现形式，对于所有脑放疗后出现局灶性神经功能缺损的患者均需考虑。迫切需要针对SMART综合征经过验证的诊断和治疗方法。
