Early-onset stroke-like migraine attacks after radiation therapy syndrome: A case report and review of the literature

Ariana Chow; Gabrielle E A Hovis; Farinaz Ghodrati; Maya Harary; Khashayar Mozaffari; Anjali Pradhan; John Hegde; Isaac Yang

doi:10.1016/j.jocn.2024.110983

Early-onset stroke-like migraine attacks after radiation therapy syndrome: A case report and review of the literature

J Clin Neurosci. 2024 Dec 14:132:110983. doi: 10.1016/j.jocn.2024.110983. Online ahead of print.

Authors

Ariana Chow¹, Gabrielle E A Hovis¹, Farinaz Ghodrati², Maya Harary¹, Khashayar Mozaffari³, Anjali Pradhan², John Hegde⁴, Isaac Yang⁵

Affiliations

¹ Departments of Neurosurgery, University of California, Los Angeles, CA, United States.
² Departments of Neurosurgery, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
³ Departments of Neurosurgery, University of California, Los Angeles, CA, United States; Radiology, University of California, Los Angeles, CA, United States.
⁴ Radiation Oncology, University of California, Los Angeles, CA, United States.
⁵ Departments of Neurosurgery, University of California, Los Angeles, CA, United States; Radiation Oncology, University of California, Los Angeles, CA, United States; Head and Neck Surgery, University of California, Los Angeles, CA, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, United States; Los Angeles Biomedical Research Institute, University of California, Los Angeles, CA, United States; Harbor-UCLA Medical Center, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, University of California, Los Angeles, CA, United States. Electronic address: [email protected].

PMID: 39675213
DOI: 10.1016/j.jocn.2024.110983

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Brain radiation; Delayed onset; SMART syndrome; Stereotactic radiosurgery; Stroke-like migraine attacks after radiation therapy.

Publication types

Review