Chow Ariana, Hovis Gabrielle E A, Ghodrati Farinaz, Harary Maya, Mozaffari Khashayar, Pradhan Anjali, Hegde John, Yang Isaac
Departments of Neurosurgery, University of California, Los Angeles, CA, United States.
Departments of Neurosurgery, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
J Clin Neurosci. 2025 Feb;132:110983. doi: 10.1016/j.jocn.2024.110983. Epub 2024 Dec 15.
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is characterized by migraines, seizures, and stroke-like symptoms following brain irradiation. Diagnosis consists of clinical signs, history of brain irradiation, and radiographic evaluation. The latency to onset varies widely among individual patients, ranging from 1 to 35 years. Herein, we review the literature and present a case of SMART syndrome with an onset of five months after stereotactic radiosurgery for a benign meningioma.
A systematic review of the literature was conducted in line with the PRISMA guidelines. The PubMed, Cochrane, and Web of Science databases were searched for cases of SMART syndrome with reported time of onset and radiation dosage. Finally, we report the presentation, history, radiographic findings, and clinical outcomes of a 48-year-old female with suspected SMART syndrome.
Of 101 articles reviewed, 23 articles were selected for inclusion in the present study. A total of 27 cases were identified. The mean age at presentation was 43 years (range: 11-70), and 71.4 % of patients were male. The mean latency to onset was 11.2 years after radiation. Based on case descriptions, none of the patients were definitively treated with single fraction radiosurgery.
SMART syndrome may present with variations in latency to onset, radiation dose, outcome, and clinical course. The present case of SMART syndrome highlights the variety in clinical presentation of this disease. Further work should be considered to better determine whether clinical and radiographic criteria for diagnosing SMART syndrome diagnosis are sufficient to encompass patients with a non-traditional presentation.
放射治疗后类卒中偏头痛发作（SMART）综合征的特征是在脑部放疗后出现偏头痛、癫痫发作和类卒中症状。诊断包括临床体征、脑部放疗史和影像学评估。个体患者的发病潜伏期差异很大，从1年到35年不等。在此，我们回顾文献并报告一例在立体定向放射外科治疗良性脑膜瘤后5个月发病的SMART综合征病例。
根据PRISMA指南对文献进行系统回顾。在PubMed、Cochrane和科学网数据库中搜索有报道发病时间和放射剂量的SMART综合征病例。最后，我们报告一名疑似SMART综合征的48岁女性的临床表现、病史、影像学检查结果和临床结局。
在 reviewed的101篇文章中，23篇文章被选入本研究。共确定了27例病例。发病时的平均年龄为43岁（范围：11 - 70岁），71.4%的患者为男性。放射治疗后发病的平均潜伏期为11.2年。根据病例描述，没有患者接受单次分割放射外科的确切治疗。
SMART综合征在发病潜伏期、放射剂量、结局和临床病程方面可能存在差异。本SMART综合征病例突出了该疾病临床表现的多样性。应考虑进一步开展工作，以更好地确定诊断SMART综合征的临床和影像学标准是否足以涵盖非传统表现的患者。
